OF PANCREATIC PSEUDOCYSTS

ABSTRACT – Background- Surgery is the traditional treatment for symptomatic pancreatic pseudocysts, but the morbidity is still too high. �inimally in�asi�e endoscopic approaches ha�e been encouraged. Aims- To e�aluate the efficacy of endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts. Methods- From January, 2003 to August, 2006, 31 consecuti�e symptomatic patients submitted to 37 procedures at the same endoscopic unit were retrospecti�ely analysed. Chronic and acute pancreatitis were found in, respecti�ely, 17 (54.8%) and 10 (32.3%) cases. Bulging was present in 14 (37.8%) cases. Cystogastrostomy or cystoduodenostomy were created with an inter�entional linear echoendoscope under endosonographic and fluoroscopic control. By protocol, only a single plastic stent, without nasocystic drain, was used. Straight or double pigtail stents were used in, respecti�ely, 22 (59.5%) and 15 (40.5%) procedures. Results- Endoscopic ultrasound-guided transmural drainage was successful in 29 (93.5%) patients. Two cases needed surgery, both due to procedure-related complications. There was no mortality related to the procedure. Twenty-four patients were followed-up longer than 4 weeks. During a mean follow-up of 12.6 months, there were six (25%) symptomatic recurrences due to stent clogging or migration, with two secondary infections. �edian time for de�eloping complications and recurrence of the collections was 3 weeks. These cases were successfully managed with new stents. Complications were more frequent in patients treated with straight stents and in those with a recent episode of acute pancreatitis. Conclusions- Endoscopic transmural drainage pro�ides an effecti�e approach to the management of pancreatic pseudocysts. HEADINGS – Pancreatic pseudocyst. Drainage. Endosonography. Prostheses and implants