Endoscopic retrograde pancreatography in the surgery of pancreatic pseudocysts

Endoscopic retrograde pancreatography (ERP) was performed on 83 patients with 99 pancreatic pseudocysts (PCP). ERP was successful in 76 patients; in the other seven PCPs were found at operation. Five characteristic ductal patterns are described and illustrated. The PCPs were situated in the head (51 patients), body (21 patients), tail (20 patients). Thirteen PCPs were less than 2 cm, 50 were between 2 and 5 cm, 29 greater than 5 cm. There were multiple PCPs in 13.2% of patients. ERP was a more accurate diagnostic measure than ultrasonography or upper gastrointestinal roentgenograms, revealing the lesion in 89% of patients. Eight patients with pancreatic ascites had the causative PCP demonstrated prior to operation. Three patients had pancreatic pleural effusions; two with effusions on the right had PCPs of the tail. Five patients had spontaneous connections between a PCP and the stomach (four patients) or duodenum (one patient). Rational surgical planning for the management of PCPs is greatly facilitated by preliminary reconnaisance by ERP.