Acute vs. chronic pancreatitis: Implications for endoscopic pseudocyst drainage

E. Elton, D. A. Howell, Glen Lehman, T. H. Baron, Stuart Sherman, T. Qaseem, W. G. Parsons

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Endoscopic drainage of pancreatic pseudocysts has become an increasingly common procedure. However, few data are available comparing the presentation, treatment, and outcome of patients with pseudocysts in the setting of acute pancreatitis as compared to chronic pancreatitis. Methods: Between 2/89 and 10/96, 123 patients underwent an attempt at endoscopic pseudocyst drainage at our three institutions. We excluded 14 who had a technical failure of the procedure, and 9 who had pancreatic cancer. We then reviewed the remaining 100 cases with respect to acute (n=45) or chronic (n=55) underlying pancreatitis. Mean follow-up was 18 months. Results: Acute Chronic (n=45) (n=55) p value Presentation sex: % male 51% 71% 0.04 average size (cm) 11.9 76 <0.002 expanding pseudocyst 49% 19% 0001 primary complications * 36% 62% 0.009 pancreatic necrosis 33% 2% <0.0001 multiloculated cyst 11% 16% NS disrupted duct 42% 9% <0.0001 communication 13% 51% <0.0001 strictured duct 4% 35% <0.0002 Treatment transmural 80% 51% 0.003 transpapillary 24% 51% 0.007 Outcome treatment complication 27% 17% NS infection 20% 7% NS bleeding 2% 4% NS perforation 4% 4% NS resolulion 87% 94% NS recurrence 13% 15% NS required retreatment 38% 31% NS * defined as obstructive jaundice, duodenal obstruction, varices, leaking or infected pseudocysts, ductal stones, and pseudoaneurysms. Conclusion: Although there are significant differences in some aspects of the presentation of pseudocysts in acute and chronic pancreatitis, and although those occurring with acute pancreatitis are more amenable to transmural rather than transpapillary drainage, the outcome with regard to complications, resolution, recurrence, and need for retreatment is similar in both groups.

Original languageEnglish
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997
Externally publishedYes

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Chronic Pancreatitis
Pancreatitis
Drainage
Retreatment
Duodenal Obstruction
Pancreatic Pseudocyst
Recurrence
Obstructive Jaundice
False Aneurysm
Varicose Veins
Pancreatic Neoplasms
Cysts
Necrosis
Communication
Hemorrhage
Infection
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Elton, E., Howell, D. A., Lehman, G., Baron, T. H., Sherman, S., Qaseem, T., & Parsons, W. G. (1997). Acute vs. chronic pancreatitis: Implications for endoscopic pseudocyst drainage. Gastrointestinal Endoscopy, 45(4).

Acute vs. chronic pancreatitis : Implications for endoscopic pseudocyst drainage. / Elton, E.; Howell, D. A.; Lehman, Glen; Baron, T. H.; Sherman, Stuart; Qaseem, T.; Parsons, W. G.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

Elton, E. ; Howell, D. A. ; Lehman, Glen ; Baron, T. H. ; Sherman, Stuart ; Qaseem, T. ; Parsons, W. G. / Acute vs. chronic pancreatitis : Implications for endoscopic pseudocyst drainage. In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4.
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AU - Elton, E.

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AB - Background: Endoscopic drainage of pancreatic pseudocysts has become an increasingly common procedure. However, few data are available comparing the presentation, treatment, and outcome of patients with pseudocysts in the setting of acute pancreatitis as compared to chronic pancreatitis. Methods: Between 2/89 and 10/96, 123 patients underwent an attempt at endoscopic pseudocyst drainage at our three institutions. We excluded 14 who had a technical failure of the procedure, and 9 who had pancreatic cancer. We then reviewed the remaining 100 cases with respect to acute (n=45) or chronic (n=55) underlying pancreatitis. Mean follow-up was 18 months. Results: Acute Chronic (n=45) (n=55) p value Presentation sex: % male 51% 71% 0.04 average size (cm) 11.9 76 <0.002 expanding pseudocyst 49% 19% 0001 primary complications * 36% 62% 0.009 pancreatic necrosis 33% 2% <0.0001 multiloculated cyst 11% 16% NS disrupted duct 42% 9% <0.0001 communication 13% 51% <0.0001 strictured duct 4% 35% <0.0002 Treatment transmural 80% 51% 0.003 transpapillary 24% 51% 0.007 Outcome treatment complication 27% 17% NS infection 20% 7% NS bleeding 2% 4% NS perforation 4% 4% NS resolulion 87% 94% NS recurrence 13% 15% NS required retreatment 38% 31% NS * defined as obstructive jaundice, duodenal obstruction, varices, leaking or infected pseudocysts, ductal stones, and pseudoaneurysms. Conclusion: Although there are significant differences in some aspects of the presentation of pseudocysts in acute and chronic pancreatitis, and although those occurring with acute pancreatitis are more amenable to transmural rather than transpapillary drainage, the outcome with regard to complications, resolution, recurrence, and need for retreatment is similar in both groups.

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