Several authors have suggested that pancreatic ductal anatomy in pancreatic pseudocysts (PP) is important in planning the approach to drainage as well as in predicting natural history. Few studies, however, have included details of anatomy and no study to date has reported follow-up ductography after PP resolution. PATIENTS: Patient selection and criteria for drainage at three referral medical centers have been reported previously (Gastroint Endosc 1995:41:424A). 108 patients undergoing endoscopic drainage had pre-drainage ERCPs successfully obtained in 97 (89%). Reasons for failure included duodenal or gastric luminal compression. Ductal abnormalities were characterized as intact to the tail without communication (n=5). completely obstructed (n=29), disrupted with a transection-like injury with leakage into the PP and failure to fill to the tail (n=23). and communicating with the PP from an intact duct (n=38). Significant stricturing was found in 31 of the total. Furthermore, at the time of stent removal or extraction of transmural drains, repeat pancreatography was completed in 49 patients which were compared to the pre-drainage studies. In patients with complete obstruction, there was no instance of recanalization to the more distal duct. With disruption and communication there was sealing of the leaks upon resolution. Two disruptions healed with recommunication to the duct of the tail (2/14.14%), otherwise, no change in main ductal anatomy was noted. Of 16 restudied strictures, only 2 resolved (12%). CONCLUSIONS: Patients undergoing endoscopic drainage had, in general, severe ductal injuries likely explaining their persisting or expanding PP. In follow-up, other than healing of the fistulas, ductal obstruction or transection did not revert towards normal and strictures infrequently resolved. These follow-up findings suggest that pancreatic ductal anatomy can be used at the time of initial ERCP to predict natural history and guide therapy.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging