The Efficacy of Endoscopic Drainage of Pancreatic Pseudocysts

Kristina Spate, MD, Hannah Palin, Michael Egger, MD, Gary C Vitale, MD

Department of Surgery, University of Louisville

Introduction: Mature, symptomatic pancreatic pseudocysts can be managed by an operative or endoscopic approach. The goal of our study is to report the outcomes following a large series of patients who underwent endoscopic pseudocyst drainage at our institution.

Methods: A retrospective chart review was performed on all patients who underwent endoscopic drainage of a pancreatic pseudocyst during the years 2007 to present. The patient data was analyzed with respect to demographics, presence of infection, average number of ERCPs performed, time to resolution following intervention, rate of failure requiring operative drainage and overall morbidity and mortality.

Results: A total of 56 patients had an endoscopic pseudocyst drainage by either a transgastric, transpapillary or combined approach attempted during the study period. There were 27 females and 29 males with a mean age of 55 years. 7 patients were determined to not be amenable to drainage at the time of endoscopy for a total of 49 patients included in this study. Patients underwent endoscopic drainage by a transmural (n=18), transpapillary (n=16), or a combined approach (n=15). The mean size of pancreatic pseudocyst was 11.2cm (range 2-22cm). 37 patients (75%) had sterile pancreatic pseudocysts while 12 patients (25%) had an infected pseudocyst at the time of drainage. 80% of patients (n=39) had complete resolution of their pseudocyst while 8% (n=4) had a greater than 50% reduction in the size following intervention. 2% (n=1) failed to have a reduction in size of their pseudocyst. 10% of patients (n=5) did not improve after endoscopic drainage and required operative intervention. The mean time to resolution was 7.5 months (range 2-24). The overall complication rate was 6% (n=3) with bleeding (n=2) and a tension pneumothorax (n=1) associated with the procedure. There were 2 unrelated deaths in patients with metastatic cancer which were not procedure related during the study period.

Conclusion: Endoscopic drainage of a symptomatic, mature pancreatic pseudocyst can be performed safely with an overall success rate of 88% and should be attempted prior to an operative approach when an endoscopic drainage is technically feasible.

Session: Podium Presentation

Program Number: S040