Pancreatic pseudocysts: clinical and endoscopic experience

Records of 51 patients with proven pancreatic pseudocyst (PC) were retrospectively reviewed to assess clinical and endoscopic variables. Thirty-nine had surgery after preoperative endoscopic retrograde cholangiopancreatography (ERCP), six patients had ERCP only, and six patients had surgery without prior ERCP. Forty-two pancreatograms were obtained, and all were abnormal. PC communication with the pancreatic duct was present in 29 and ductal obstruction downstream from the PC was shown in 11 studies. Thirty-five cholangiograms were obtained and 19 were abnormal, including ductal narrowing in 16 and biliary calculi in three. PC contents were cultured intraoperatively in 29 patients, and 17 were positive. PC infection was highly correlated with the incidence of recurrent hospitalizations and with PC recurrence. PC infection did not occur significantly more often in patients with communicating PC or in those with preoperative ERCP. Factors that did not influence outcome included PC size, multiplicity, anatomic location, and PC communication with the pancreatic duct. Results from both ERCP and culture of PC contents add significantly to our knowledge of PC disease.