Elsevier

Gastrointestinal Endoscopy

Volume 42, Issue 3, September 1995, Pages 219-224
Gastrointestinal Endoscopy

Transpapillary and transmural drainage of pancreatic pseudocysts☆,☆☆,★

Presented in part at the American Society for Gastrointestinal Endoscopy Annual Meeting, Boston, Massachusetts, May 1993
https://doi.org/10.1016/S0016-5107(95)70095-1Get rights and content

Abstract

Background: Endoscopic drainage of pseudocysts using the transpapillary and transmural approaches has been reported. We evaluated endoscopic drainage in 53 patients with symptomatic pancreatic pseudocysts in whom conservative management had failed.

Methods: After preliminary endoscopic retrograde pancreatography, transpapillary drainage was attempted in 33 patients with pseudocysts that communicated with the main pancreatic duct. Transmural drainage of pseudocysts in contact with the stomach or duodenal wall was attempted in the remaining 20 patients and in 4 patients selected for combined transpapillary and transmural drainage. The cause of pseudocysts was chronic pancreatitis in 92. The median pseudocyst size was 7.0 cm (range, 2 to 16).

Results: Endoscopic drainage was technically successful in 50 patients (94%), of whom 47 had complete pseudocyst resolution. Complications occurred in 11% and included gallbladder puncture (n = 1) and bleeding (n = 2) after transmural drainage, and pancreatitis (n = 1) after transpapillary drainage; stent clogging resulted in abscess formation in 2 patients. Mean follow-up was 22 months (range, 1 to 70); pseudocysts recurred in 11 patients (23%), of whom 7 were successfully re-treated endoscopically.

Conclusion: Both transpapillary and transmural pseudocyst drainage are highly effective in patients with pseudocysts demonstrating suitable anatomy for these endoscopic techniques. (Gastrointest Endosc 1995;42:219-24.)

Section snippets

Patients

Over a 7-year period (1985 to 1992), 53 patients (41 men, 12 women) with a mean age of 47 years (range, 24 to 76) underwent 57 endoscopic drainage procedures for definable pancreatic fluid collections consistent with pseudocysts on computed tomography or ultrasonography. Twenty-nine patients underwent transpapillary drainage, 20 patients transmural drainage, and 4 patients combined transpapillary and transmural drainage.

All patients selected for endoscopic therapy were symptomatic, had failure

RESULTS

Endoscopic stent drainage of pancreatic pseudocysts was successful in 50 of the 53 patients treated. Transpapillary stents were successfully placed in all 33 attempted procedures, whereas transmural drainage failed in 4 of 24 attempted procedures. Failure was due to complications in 3 patients (bleeding in 2 and gallbladder puncture in 1) and inadequate penetration of the pseudocyst cavity in 1 patient.

One patient did not have pseudocyst communication with the pancreatic duct on ERP and there

DISCUSSION

The aim of endoscopic treatment of pancreatic pseudocysts is to create a communication between the pseudocyst cavity and the bowel lumen. Two approaches have been described: transpapillary and transmural drainage. The prerequisite for each of these approaches is suitable anatomy. Transpapillary drainage can be performed if the pseudocyst communicates with the main pancreatic duct, and transmural drainage if there is direct apposition of the pseudocyst against the stomach or duodenal wall.

In

Acknowledgements

The authors wish to thank Drs. Sanjay Sikka and Mary C. Portis for their valuable assistance in preparing this manuscript.

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0016-5107/95/4203-0219$5.00 + 0

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Reprint requests: Kenneth F. Binmoeller, MD, Endoscopic Surgery, University Hospital Eppendorf, Martinistrasse 52, Hamburg, Germany.

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Copyright © 1995 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.