ENDOSCOPIC DRAINAGE OF PANCREATIC PSEUDOC YSTS - A REPORT OF 26 CASES

Endoscopic drainage of pancreatic pseudocysts has been proposed for se veral years as an alternative to surgical treatment. We report the res ults of 26 endoscopic cystostomies of pancreatic pseudocysts (13 cysto duodenostomies, 13 cystogastrostomies) performed in two specialized ce ntres, from 1985 to 1991. The patients were divided into 3 groups (I, II, III) according to the pseudocysts' clinical presentation. The open ing of the collection into digestive lumen was achieved in 22 cases; t here were 3 puncture failures and 1 cystostomy was not performed becau se of a prior haemorrhagic puncture. Pain relief was obtained rapidly after cystodigestive drainage in 13 out of the 14 symptomatic patients . Three complications required surgery: 1 bleeding after cystoduodenos tomy, 1 perforation and 1 peritonitis after cystogastrotomies. Two of them occurred after recutting a cystostomy. Two pseudocyst surinfectio ns healed with antibiotic therapy. No deaths occurred due to the proce dure. Among the 18 long-term followed-up patients (average = 33 months ), 4 required surgery for persistence or relapse of pseudocysts. The r esults were excellent for the 14 other patients without any difference between cystoduodenostomies and cystogastrostomies, neither between t he I, II and III groups. Each of the 5 cases with a digestive lumen-ps eudocyst cavity thickness above 1 cm (measured on 20 CT scans) failed: 1 puncture failure, 3 complications, 1 relapse.