Management of pancreatic pseudocysts

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Interventional Radiology

Background:

• Chronic unresolved pancreatic pseudocysts (PPs) traditionally treated with operative internal drainage.
• Percutaneous external drainage (PED) has emerged as a primary treatment modality in many centers.

Purpose of the Study:

• To compare the efficacy and outcomes of operative management versus CT-guided PED for chronic PPs.
• To evaluate the long-term recurrence rates and need for salvage procedures for different management strategies.

Main Methods:

• Retrospective chart review of 96 patients with PPs managed between 1987 and 1996.
• Data collection included initial treatment, outcomes, complications, and long-term follow-up via telephone and mail questionnaire.

Main Results:

• CT-guided PED in 27 patients resulted in resolution in 17, but 7 (26%) required urgent pancreatic debridement and 2 (7%) underwent cystgastrostomy due to deterioration or infection.
• Operative management (cystgastrostomy/jejunostomy, pancreatectomy, etc.) in 32 patients had fewer immediate complications, though 6% needed further intervention.
• Long-term follow-up (median 3 years) showed recurrence rates of 23% for PED, 14% for surgery, and 19% for expectant management.

Conclusions:

• Operative management demonstrates superior outcomes compared to CT-guided PED for chronic pancreatic pseudocysts.
• CT-guided PED, while often successful, necessitates major salvage procedures in a significant proportion of patients.
• An expectant management approach may be appropriate for carefully selected patients with PPs.