TREATMENT OF PANCREATIC PSEUDOCYSTS WITH DUCTAL COMMUNICATION BY TRANSPAPILLARY PANCREATIC DUCT ENDOPROSTHESIS

Background: Endoscopic treatment of pancreatic pseudocysts via cystent erostomy has been recognized as a successful treatment option in caref ully selected patients. Pancreatic transpapillary stenting as an alter native treatment option in patients with pancreatic pseudocysts direct ly communicating with the main duct has received little consideration. The aim of the current study was to assess the safety and utility of transpapillary pancreatic endoprosthesis in the treatment of communica ting pseudocysts. Methods: Twenty-one patients underwent placement of 33 transpapillary endoprostheses for the treatment of symptomatic panc reatic pseudocysts. All pseudocysts communicated with the main pancrea tic duct and ranged in size from 3 to 9 cm (mean 6 cm). Eight patients had associated pancreatic duct strictures. Results: Stent placement w as successful in all cases: 13 directly into the pseudocyst, 8 beyond the stricture but not into the pseudocyst. Initial resolution of pseud ocysts was seen in 17 patients, with 16 patients free of pseudocyst re currence al mean follow-up of 37 months. All patients with associated strictures were treated successfully. Factors predictive of success in cluded presence of strictures, size of pseudocyst greater than or equa l to 6 cm, location in the body of the pancreas, and duration of pseud ocyst less than 6 months. Complications included one episode of mild p ancreatitis. Conclusions: Endoscopic treatment of symptomatic pancreat ic pseudocysts with ductal communication by transpapillary pancreatic duct stenting is a safe, effective modality and should be considered a first line therapy.