PERCUTANEOUS DRAINAGE OF PANCREATIC PSEUDOCYSTS

Abstract

Pancreatic pseudocysts (PP) may be classified into: 1. Postnecrotic PP produced by an attack of acute pancreatitis on a normal pancreas; 2. Post-necrotic PP produced by an attack of acute pancreatitis superimposed on a chronic pancreatitis; 3. Chronic pancreatitis PP (“retention cysts”); 4.Post-operative PP.

The differential diagnosis between inflammatory and neoplastic lesions must be pursued both at the initial diagnostic work-up and during the post-treatment follow-up. Every lesion of uncertain etiology must be resected.

Percutaneous drainage (PD) is one of the therapeutical options currently available for PP and it is indicated for: 1. Post-necrotic PP produced by an attack of acute pancreatitis (either on a normal pancreas or on a chronic pancreatitis), large (> 6 cm), rapidly expanding or symptomatic; 2. Post-operative PP. PD may also be indicated for a small, highly selected, group of chronic pancreatitis PP symptomatic but without critical duct stenoses. In these patients a PD, often therapeutic, may also be employed to decompress a “retention cyst” in order to improve patients’ general conditions before surgery.

Post-necrotic PP that are asymptomatic or small (< 6 cm) should be managed non-operatively. The majority of chronic pancreatitis PP, all those with a clearly enlarged pancreatic duct or associated with other conditions not amenable to percutaneous resolution, require surgery.

In our experience PD was feasible in all but one case (95/96). The initial diagnosis of PP was confirmed in 92 cases. The overall morbidity was 18% with no specific mortality. Overall 3-year success rate was 85% with well evident variations among different PP types.