Endoscopic cyst gastrostomy for traumatic pancreatic. Pdf treatment of pancreatic pseudocysts researchgate. Read diagnosis and management of pancreatic pseudocysts. Get a printable copy pdf file of the complete article 773k, or click on a page image below to browse page by page. The pancreas is an organ that sits behind your stomach. 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. Management of pancreatic pseudocysts and walledoff pancreatic. Pancreatic pseudocysts vanderbilt university medical center. 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. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic. Therefore, being a minimally invasive technique, endoscopic drainage could be an appropriate alternative to surgery in the management of pancreatic pseudocysts.
Metal stents in management of pancreatic pseudocyst and. An endoscopic ultrasound eusguided transgastric endoscopic approach is preferred if there is favourable access to the pp. Successful endoscopic cyst gastrostomy has been reported in children with pancreatic pseudocysts. Full text full text is available as a scanned copy of the original print version. The natural history is to resolve spontaneously in a period of 46 weeks in more than 85% of the time. Management of pancreatic pseudocystsa retrospective analysis.
Get a printable copy pdf file of the complete article 773k. T he evaluation and management of pancreatic pseudocysts has changed dramatically. Classification and management of pancreatic pseudocysts. Endoscopic drainage of pancreatic pseudocysts guided by endosonography. Grade system for rating the quality of evidence for guidelines.
We have adopted a more conservativeapproach with drainage only for uncontrolled pain or gastric outlet obstruction. It gives an introduction to pancreatic cancer, explains your diagnosis, and provides an overview of the treatment options. Management of symptomatic pancreatic pseudocyst springerlink. Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. Early management focuses on advancements in our understanding of aggressive intravenous hydration, which when applied early appears to decrease morbidity and mortality 9,10. Traditional surgical approaches to the management of pseudocyst are now being challenged by endoscopic techniques and interventional radiology. Modern management of pancreatic pseudocysts grace 1993. Pdf management of pancreatic pseudocysts stig bengmark. 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.
Evaluation and management of pancreatic pseudocysts. Links to pubmed are also available for selected references. More commonly seen in won than pseudocysts pancreatic duct leaks lead to recurrence of fluid collections. Gastroscopic and ultrasoundguided percutaneous cystgastrostomy. Adams, md, facs the fascination that pseudocysts hold for surgeons is beyond comprehension. Delineation of the anatomy with mrcp or ercp is the first step in management. More randomized studies are needed to look at the long term outcome and cost effectiveness of metal stent use in pancreatic pseudocyst management. However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of. Background pancreatic pseudocysts may develop after highgrade pancreatic injuries in children. The traditional management of pancreatic pseudocyst pp is surgical drainage. The role of endoscopy in the diagnosis and treatment of. Management of pancreatic pseudocysts is associated with considerable morbidity 15 25%. It makes fluids that flow through a duct into the small intestine.
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. Evidencebased treatment of pancreatic pseudocysts see equal ef. Pdf a clinical study of pancreatic pseudocyst and its. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal trauma. Management of a recurrent pancreatic pseudocyst sages. Management of pancreatic pseudocystsa retrospective. Currently, the preoperative diagnosis of a pancreatic cyst is based on clinical and imaging. 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. Much debate exists regarding which of these approaches is superior and when each is most appropriate.
Pancreatic pseudocyst is a welldefined fluid collection, but without solid components, which occurs 4 weeks after an interstitial or edematous pancreatitis episode. Management of pancreatic pseudocysts andersson 1989. In our study, the resolution rate of pancreatic pseudocysts did not differ significantly between the surgical and the endoscopic groups 93. Management options for pancreatic pseudocyst are numerous and include endoscopic and surgical approaches. This article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. Open surgical drainage to the stomach or a jejunal roux limb, the primary therapy. The role of surgery in the management of acute pancreatitis. 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. 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. Most pseudocysts resolve on their own without treatment, over time. Pancreatic pseudocysts may be a result of acute or chronic pancreatitis and trauma including postsurgical. Gastroenterologists, surgeons, and invasive radiologists must work together to determine the necessity, timing, and method of intervention. According to the atlanta classification an acute pseudocyst is a collection of pancreatic.
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 case report describes a rare complication of an eusguided transgastric drainage of a pp secondary to a suboptimally. Classification and management of pancreatic pseudocysts ncbi. 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. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. Pdf according to the atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation.
Pancreatic pseudocysts arise mostly in patients with alcohol induced chronic pancreatitis causing various symptoms and complications. However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of optimal therapy. Diagnosis and management of pancreatic pseudocysts. Diagnosis and management of pancreatic pseudocysts, pancreatic.
Mean hospital stay was days among patients treated conservatively and 30 days in both percutaneously and surgically treated patients. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a. 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. Robert zollinger, md overview the pancreatic pseudocyst is a collection of pancreatic secretions contained within a fibrous sac comprised of chronic inflammatory. Pseudocysts can be medically managed with pancreatic rest or surgically by internal or external drainage. Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery.
The evaluation and management of pancreatic pseudocysts has changed dramatically. Pdf management of pancreatic pseudocysts magnus janzon. Review of management options for pancreatic pseudocysts ncbi. Although pseudocyst formation is an uncommon sequela of acute or chronic pancreatitis in children, complications of pancreatic pseudocysts include spontaneous rupture, hemorrhage, and infection. Often pseudocysts get better and go away on their own. Pancreas pseudocyst an overview sciencedirect topics. A pancreatic pseudocyst happens when the ducts in your pancreas get blocked because of disease or injury. Pdf surgical treatment of pancreatic pseudocysts researchgate. Laparoscopic management of pancreatic pseudocysts offers the benefits of minimal access surgery to patients. Some have suggested that pseudocysts associated with acute pancreatitis are more likely to contain inflamma tory fluid 21 than pancreatic juice, but there are. Many resolve without intervention, and the management of symptomatic pseudocysts that persist remains controversial, with various open, percutaneous and laparoscopic approaches to intervention described. Management of pseudocysts requires a team approach. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial, by varadarajulu s.
If nonsurgical drainage is contemplated, it is important to elucidate the anatomy of the pancreatic duct beforehand. Pancreatic pseudocysts are collections of leaked pancreatic fluids. Traditionally, pancreatic pseudocysts have been drained because of the perceived risks ofcomplications including infection, rupture or haemorrhage. If not, or if it causes a lot of pain or other symptoms. Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7. Pancreatic cysts and pseudocysts management and treatment.
Two patients 6% had persistent chronic pain and one patient 3% had evidence of exocrine pancreatic insufficiency with malabsorption. Pdf a pancreatic pseudocyst is the collection of pancreatic secretions surrounded by fibrous tissue caused by pancreatic disease that affects. The management of pancreatic pseudocysts is complex and can range from simple observation to aggressive endoscopic and surgical interventions to treat symptomatic lesions. Pseudocysts during chronic calcifying pancreatitis ccp. The management of pancreatic pseudocyst katherine a. 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. Management of pancreatic pseudocysts edinburgh research. 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. Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. Pediatric pancreatitis and pancreatic pseudocyst treatment.
Methods an online survey in pubmed was conducted using the terms acute pancreatitiscomplications, pancreatic pseudocyst and pancreatic pseudocyst treatment. Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery, have been employed for the management of pancreatic pseudocysts. Patients with asymptomatic cysts that are diagnosed as pseudocysts on initial imaging and. If a pseudocyst is small and not causing serious symptoms, a doctor may want to. Patients with asymptomatic cysts that are diagnosed as pseudocysts.
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. However, when symptoms become persistent, complications emerge, or cysts become larger than 6 centimeters in size, drainage is indicated. Abstractthis article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. Pdf classification and management of pancreatic pseudocysts.
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