Pancreatic endoscopy is useful for the pain of chronic pancreatitis: PANCREATIC PSEUDOCYSTS Part 1

Pancreatic endoscopyPancreatic pseudocysts should be drained, if possible, in symptomatic patients. Endoscopic drainage of these collections is an increasingly popular procedure. Several investigators have reported success rates of 65% to 95%, with complication rates of 10% to 35%. Complications include infection, hemorrhage, perforation and pancreatitis.

At Duke University, our approach is to drain the pseudocyst through the ‘transgut’ (transgastric or transduodenal) approach, especially if the lesion abuts these structures. Transgut drainage is usually preceded by a needle puncture to verify location (with fluid aspiration or contrast injection). A tract to the pseudocyst is created by diathermy needle cautery, followed by the placement of a guidewire, over which balloon dilation is performed and one or more double pigtail stents are inserted. We usually dilate the tract to 12 mm diameter. Computerized tomography or ultrasound imaging should be repeated in two to three weeks, and the stent(s) should be removed if the pseudocyst has resolved. Bleeding is the most worrisome complication, and is more likely if there is thrombosis of the splenic or portal veins. Most experts require that two criteria be satisfied before transgut drainage is undertaken: there must be an obvious indentation of the luminal wall by the pseudocyst, and the transmural distance to the pseudocyst, measured by computerized tomography or ultrasound, should be no greater than 1 cm.
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Our current practice is to perform endoscopic ultrasonography to help localize and mark the pseudocyst and evaluate its contents, and to identify any vascular structures that may be in the way of drainage. If there are septae or a large amount of necrotic debris in the pseudocyst, then either a percutaneous approach, which allows easier flushing of debris, or surgery should be considered.

This entry was posted in Pancreatic endoscopy and tagged Chronic pancreatitis, Pancreatic endoscopy.