| Objective:Transpapillary approach can be used for pseudocyst drainage when PPC communicated with the main pancreatic duct, espccially for pseudocyst with pancreatic-duct abnormality. Our purpose is to analyze the efficacy, recurrence rate and prognostic factors for clinical success of endoscopic pseudocyst transpapillary drainage.Methods:Data on all patients who were undergoing transpapillary drainage between November 2000 and September 2009 were entered into a computerized database. Patient data, pseudocyst characteristics, drainage technique, and outcomes were obtained through restrospective review. Prospective follow-up to determine long-term outcome was carried out.Results:1. Total procedures of interventional ERCP were 70 in 43 patients.36 of the 43 patients underwent pancreatic-duct stent drainge, nasocystic catheters in 3 patients and a combination of stent plus nasocystic catheter in 3 cases. The technical success rate for acute pseudocyst drainage was 90.7%(39 of 43 patients), for chronic pseudocyst drainage 89.5%(17/19, P=1.00 VS. acute pseudocyst).2. The overall clinical success rate was 79.5%(31 of 39 patients). The clinical success rate for acute pseudocyst drainage was 85.7%(18/21), for chronic pseudocyst drainage 70.6%(12/17, P=0.426 VS. acute pseudocyst).3. Complications occurred in 7 of 43 patients (16.3%). Complications related to acute pseudocyst drainage occurred in 4 of 23 patients (17.4%), to chronic pseudocyst drainage in 3/19 (15.8%, P=1.00 VS. acute pseudocyst).4. The mean hospital stay for all patients undergoing transpapillary drainage was 10.2±9.2 days (range 2-48 days). Median follow-up was 774 days (range 61-3256 days) for 39 patients. Pseudocyst recurred in 2 of 31 patients (6.5%) with PPC successfully drained endoscopically.5. There was significant difference in the clinical success rate of pancreatic head pseudocyst versus body/tail pseudocyst (62.5% vs 91.3%, P=0.045). None of the other factors tested were significant predictors of clinical success.Conclusion:Endoscopically transpapillary drainage is effective approach for the drainage of pancreatic pseudocyst. The clinical success rate of pancreatic body/tail pseudocyst drainage is higher than pancreatic head. Surgery can be reserved for those patients in whom transpapillary drainage fails.KEY WORDS:pancreatic pseudocyst, Duodenoscopy, transpapillary drainage, stentPart two EUS-guided endoscopic drainage of pancreatic pseudocysts: immediate and long-term results of a multicenter study in ChinaObjective:There is seldom multicenter, large sample reports of EUS-guided endoscopic Drainage of Pancreatic Pseudocysts now. Our purpose is to analyze the efficacy, recurrence rate and prognostic factors for clinical success of EUS-guided transmural drainage.Methods:Data on all patients who were undergoing EUS-guided transmural drainage between May 2001 and December 2009 were entered into a computerized database. Patient data, pseudocyst characteristics, drainage technique, outcomes and complications were obtained through restrospective review. Prospective follow-up to determine immediate and long-term outcome was carried out.Results:1. Pancreatography was obtained in 14 of the 93 patients before transmural drainage, communication of the pseudocyst with the main pancreatic duct was demonstrated in 1 case. Total procedures of transmural drainage were 106 in 93 patients. The overall technical success rate for transmural drainage was 96.8%(90 of 93 patients), the technical success rate for acute pseudocyst drainage was 96.3%(79/82), for chronic pseudocyst drainage 100%(9/9), for abscess drainage 100% (2/2).2. The mean size of the pseudocysts was 11.5±4.9cm. A total of 89 pseudocysts bulged into the digestive wall (95.7%). The overall clinical success rate was 94.4%(85 of 90 patients). EUS-guided transmural drainage was performed on 87 patients, EUS-guided transduodenal drainage on 6 patients.3. Complications occurred in 13 of 90 patients (14.4%). This included secondary infection (11/13), bleeding (1/13), ineffective drainage (1/13). Secondary infection is major complications.4. The mean hospital stay for all patients undergoing transmural drainage was 9.9±10.1 days (range 1-50 days). Median follow-up was 712 days (range 60-3057 days) for 90 patients. Pseudocyst recurred in 5 of 90 patients (5.6%) with pseudocyst successfully drained endoscopically.5. The clinical success rate of EUS-guided transmural drainage is significantly higher than transpapillary drainage (P＜0.05). No significant differences were observed regarding success when the number of double-pigtail stent, pseudocyst etiology, size, location, and so on were considered.Conclusion:EUS-guided transmural drainage is effective approach for microinvasive drainage of pancreatic pseudocyst and has gained acceptance as an alternative to surgical drainage. Secondary infection is major complications. The clinical success rate of EUS-guided transmural drainage is significantly higher than transpapillary drainage.Part three Etiology and characteristics in pancreatic pseudocyst: Clinical analysis of 366 casesObjective:Pancreatic pseudocysts (PPCs) arise as complication of acute and chronic pancreatitis or pancreatic trauma. But the etiologies of PPC are not the same as pancreatitis. There is seldom large sample reports of etiology in pancreatic pseudocyst now. Our purpose is to analyze the etiology, characteristics and treatment approach in pancreatic pseudocyst by retrospective review of clinic records.Methods:Medical records were reviewed and analyzed of 366 PPC patients who were admitted in changhai hospitals in China from April 2000 to December 2009 in terms of etiology and hospital course.Results:1. Of the 366 patients (249 men,117 women; mean age 48.6±13.5 years,range 9-87 years),59 patients had mild pancreatitis (59/366,16.1%),149 patients had severe acute pancreatitis (149/366,40.7%),98 patients had chronic pancreatitis (98/366,26.8%), 60 patients had no history of pancreatitis (60/366,16.4%).2. The causes of the ppc varied widely:gallstones,158patients(43.2%); idiopathic, 79(21.6%); alcohol ingestion,50(13.7%); trauma,17(4.6%); pancreatic tumor,9(2.5%); hyperlipidemia,8(2.2%); medications,7(1.9%), other,38(10.3%).3. The PPCs were classified as acute PPC in 204 patients, chronic PPC in 98 patients and abscess in 16 patients. Mean diameter of this three kinds PPC was 10.6±5.3cm, 6.1±3.5cm and 13.4±6.7cm, respectively. There is significant difference between acute and chronic PPCs located in the pancreatic head(χ2=18.275, P=0.000).4. The symptoms of the PPCs included abdominal pain (31.3%), early satiety (11.0%), fever (8.4%), enlarging cyst (6.9%). Asymptomatic PPCs were present in 48.1% of cases. 5. The complication rates of percutaneous, endoscopic, surgical drainage were 31.6%, 19.0% and 5.0%, respectively.Conclusions:1.The results of the present investigation show that gallstones is the main etiologic cause of the PPCs in China; 2. There is significant difference between acute and chronic PPCs located in the pancreatic head; 3. The main symptoms of the PPCs include abdominal pain, early satiety and fever. |
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