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Pancreatic pseudocysts: observation, endoscopic drainage, or resection?
Markus M Lerch1, Albrecht Stier, Ulrich Wahnschaffe
1Klinik und Poliklinik für Innere Medizin A, Universitätsklinikum der Ernst-Moritz-Arndt-Universität, Greifswald, Germany. lerch@uni-greifswald.de
Deutsches Arzteblatt International
|November 6, 2009
Summary
Pancreatic pseudocysts can be treated with endoscopic drainage, percutaneous drainage, or surgery. Endoscopic drainage offers a high success rate with low complications, making it a preferred method for managing pancreatic pseudocysts.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Pancreatic pseudocysts are a frequent complication of acute and chronic pancreatitis.
- Diagnosis is typically achieved through imaging studies.
- Treatment options include endoscopic drainage, percutaneous drainage, and surgical interventions.
Purpose of the Study:
- To review and compare the efficacy and safety of various treatment modalities for pancreatic pseudocysts.
Main Methods:
- A comprehensive literature search was conducted using MEDLINE, PubMed, and EMBASE databases.
- Publications from 1975 to 2008 were included in this review.
Main Results:
- Endoscopic pseudocyst drainage demonstrates a high success rate (79.2%) with a low complication rate (12.9%).
- Percutaneous drainage is primarily utilized for infected pseudocysts.
- Surgical techniques (open internal drainage, pseudocyst resection) have high success rates (>92%) but higher morbidity (16%) and mortality (2.5%) compared to endoscopic treatment (0.7% mortality).
- Laparoscopic pseudocystoenterostomy shows comparable morbidity and mortality to endoscopic methods.
Conclusions:
- An interdisciplinary approach is recommended for optimal, stage-specific treatment of pancreatic pseudocysts.
- Direct comparative randomized trials are needed to further evaluate the available interventional techniques.
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