Management of a recurrent pancreatic pseudocyst sages. Classification and management of pancreatic pseudocysts. Management of pancreatic pseudocystsa retrospective analysis. Review of management options for pancreatic pseudocysts. Aspiration or catheter drainage of pseudocyst fluid guided by ultrasonography seems a safe and effective treatment of pancreatic pseudocysts and should be considered as initial therapy. Grade system for rating the quality of evidence for guidelines. Early management focuses on advancements in our understanding of aggressive intravenous hydration, which when applied early appears to decrease morbidity and mortality 9,10. In our study, the resolution rate of pancreatic pseudocysts did not differ significantly between the surgical and the endoscopic groups 93.
Pseudocysts can be medically managed with pancreatic rest or surgically by internal or external drainage. Pdf a clinical study of pancreatic pseudocyst and its. Delineation of the anatomy with mrcp or ercp is the first step in management. Management of pancreatic pseudocysts edinburgh research. Diagnosis and management of pancreatic pseudocysts, pancreatic.
Often pseudocysts get better and go away on their own. Read diagnosis and management of pancreatic pseudocysts. Traditional surgical approaches to the management of pseudocyst are now being challenged by endoscopic techniques and interventional radiology. The role of surgery in the management of acute pancreatitis. Robert zollinger, md overview the pancreatic pseudocyst is a collection of pancreatic secretions contained within a fibrous sac comprised of chronic inflammatory. The natural history is to resolve spontaneously in a period of 46 weeks in more than 85% of the time. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. Pancreatic pseudocyst most common cystic lesions of the pancreas, accounting for 7580% of such masses location lesser peritoneal sac in proximity to the pancreas large pseudocysts can extend into the paracolic gutters, pelvis, mediastinum, neck or scrotum may be loculated 4. Much debate exists regarding which of these approaches is superior and when each is most appropriate. Pancreatic pseudocysts and walledoff pancreatic necrosis are often the result of acute pancreatitis.
The management of pancreatic pseudocyst katherine a. Classification and management of pancreatic pseudocysts ncbi. Open surgical drainage to the stomach or a jejunal roux limb, the primary therapy. Currently, the preoperative diagnosis of a pancreatic cyst is based on clinical and imaging.
Patients with asymptomatic cysts that are diagnosed as pseudocysts. Review of management options for pancreatic pseudocysts ncbi. Management of pancreatic pseudocystsa retrospective. Management of pancreatic pseudocysts and walledoff pancreatic. If not, or if it causes a lot of pain or other symptoms. This article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7. Diagnosis and management of pancreatic pseudocysts. Background pancreatic pseudocysts may develop after highgrade pancreatic injuries in children.
Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. Traditionally, pancreatic pseudocysts have been drained because of the perceived risks ofcomplications including infection, rupture or haemorrhage. Pdf according to the atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation. Modern management of pancreatic pseudocysts grace 1993. Pseudocysts during chronic calcifying pancreatitis ccp. They may form next to the pancreas during pancreatitis. Partners, family members and friends may also find it useful. The management of pancreatic pseudocysts is complex and can range from simple observation to aggressive endoscopic and surgical interventions to treat symptomatic lesions. Pancreatic pseudocyst is a welldefined fluid collection, but without solid components, which occurs 4 weeks after an interstitial or edematous pancreatitis episode.
Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery, have been employed for the management of pancreatic pseudocysts. Gastroscopic and ultrasoundguided percutaneous cystgastrostomy. Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery. Pediatric pancreatitis and pancreatic pseudocyst treatment. Patients with asymptomatic cysts that are diagnosed as pseudocysts on initial imaging and. Some have suggested that pseudocysts associated with acute pancreatitis are more likely to contain inflamma tory fluid 21 than pancreatic juice, but there are. Most pseudocysts resolve on their own without treatment, over time. Metal stents in management of pancreatic pseudocyst and.
The traditional management of pancreatic pseudocyst pp is surgical drainage. Get a printable copy pdf file of the complete article 773k, or click on a page image below to browse page by page. Pancreatic pseudocysts are collections of leaked pancreatic fluids. The role of endoscopy in the diagnosis and treatment of. Abstractthis article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. The pancreas is an organ that sits behind your stomach. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic. Endoscopic cyst gastrostomy for traumatic pancreatic. If a pseudocyst is small and not causing serious symptoms, a doctor may want to.
Management of pseudocysts requires a team approach. Full text full text is available as a scanned copy of the original print version. Pancreatic cysts and pseudocysts management and treatment. Pancreatic pseudocysts may be a result of acute or chronic pancreatitis and trauma including postsurgical. The small risk of malignant transformation, the high risks of surgical treatment, and the lack of highquality prospective studies have led to contradictory recommendations for their immediate management and for their surveillance. Pdf a pancreatic pseudocyst is the collection of pancreatic secretions surrounded by fibrous tissue caused by pancreatic disease that affects. Pdf management of pancreatic pseudocysts magnus janzon. More commonly seen in won than pseudocysts pancreatic duct leaks lead to recurrence of fluid collections. Evaluation and management of pancreatic pseudocysts. Two patients 6% had persistent chronic pain and one patient 3% had evidence of exocrine pancreatic insufficiency with malabsorption. Pancreas pseudocyst an overview sciencedirect topics. Endoscopic drainage of pancreatic pseudocysts guided by endosonography.
This case report describes a rare complication of an eusguided transgastric drainage of a pp secondary to a suboptimally. Successful endoscopic cyst gastrostomy has been reported in children with pancreatic pseudocysts. However, when symptoms become persistent, complications emerge, or cysts become larger than 6 centimeters in size, drainage is indicated. Pdf classification and management of pancreatic pseudocysts. However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a. Gastroenterologists, surgeons, and invasive radiologists must work together to determine the necessity, timing, and method of intervention. Its role in the management of pancreatic pseudocyst is gaining momentum in this era of minimal access surgery as the scope of laparoscopy widens with advancement of medical technology. A pseudocyst in connection with the main pancreatic duct and with otherwise normal pancreatic duct anatomy can often be well treated with ercpguided sphincterotomy or trans.
Management of pancreatic pseudocysts andersson 1989. Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. Management of pancreatic fluid collections pushpak taunk, m. Surgical internal drainage of pancreatic pseudocysts can be performed safely with low morbidity and mortality provided patients are carefully selected and their medical management is optimized.
Evidencebased treatment of pancreatic pseudocysts see equal ef. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal trauma. More randomized studies are needed to look at the long term outcome and cost effectiveness of metal stent use in pancreatic pseudocyst management. Methods an online survey in pubmed was conducted using the terms acute pancreatitiscomplications, pancreatic pseudocyst and pancreatic pseudocyst treatment. Pdf management of pancreatic pseudocysts stig bengmark. Adams, md, facs the fascination that pseudocysts hold for surgeons is beyond comprehension.
Management of pancreatic pseudocysts is associated with considerable morbidity 15 25%. Management of symptomatic pancreatic pseudocyst springerlink. Many resolve without intervention, and the management of symptomatic pseudocysts that persist remains controversial, with various open, percutaneous and laparoscopic approaches to intervention described. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial, by varadarajulu s. A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen. Links to pubmed are also available for selected references. T he evaluation and management of pancreatic pseudocysts has changed dramatically. Pseudocyst of the pancreas the role of cytology and special stains for mucin elvira gonzalez obeso, md 1, erin murphy, md, william brugge, md2, and vikram deshpande, md background. This change has largely been driven by better natural history data and by an increasing focus on minimally invasive approaches, but has occurred in the absence of highquality comparative effectiveness data. If nonsurgical drainage is contemplated, it is important to elucidate the anatomy of the pancreatic duct beforehand. A pancreatic pseudocyst happens when the ducts in your pancreas get blocked because of disease or injury.
An endoscopic ultrasound eusguided transgastric endoscopic approach is preferred if there is favourable access to the pp. Although pseudocyst formation is an uncommon sequela of acute or chronic pancreatitis in children, complications of pancreatic pseudocysts include spontaneous rupture, hemorrhage, and infection. Therefore, being a minimally invasive technique, endoscopic drainage could be an appropriate alternative to surgery in the management of pancreatic pseudocysts. The evaluation and management of pancreatic pseudocysts has changed dramatically. Spontaneous resolution of large pseudocysts is known to occur. Pdf treatment of pancreatic pseudocysts researchgate.
It gives an introduction to pancreatic cancer, explains your diagnosis, and provides an overview of the treatment options. Management options for pancreatic pseudocyst are numerous and include endoscopic and surgical approaches. Laparoscopic management of pancreatic pseudocysts offers the benefits of minimal access surgery to patients. Mean hospital stay was days among patients treated conservatively and 30 days in both percutaneously and surgically treated patients. Pdf surgical treatment of pancreatic pseudocysts researchgate. Patients who are not medically fi t for surgery should not undergo further evaluation of incidentally found pancreatic cysts, irrespective of cyst size strong recommendation, low quality of evidence 5. However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of optimal therapy. Get a printable copy pdf file of the complete article 773k. Pseudocysts are collections of amylaserich pancreatic juice surrounded by a wall of granulation tissue that arise following acute pancreatic inflammation or trauma, and normally form over several weeks fig.
Although a leaking pancreatic pseudocyst was the cause of ascites in at least 21 episodes 70%, an abdominal mass could only be palpated in two of 26 patients. Pancreatic pseudocysts vanderbilt university medical center. According to the atlanta classification an acute pseudocyst is a collection of pancreatic. It makes fluids that flow through a duct into the small intestine. Diagnosis and management of pancreatic in a significant number of acute cases, the cyst contents pseudocysts, pancreatic ascites. It also has information about the wider impact of being diagnosed with pancreatic cancer, and the.
1072 6 926 229 1435 963 164 329 206 897 860 343 1028 530 853 1059 52 1222 1495 275 119 275 1126 219 173 734 781 61 1277 1056 441 941 923