MANAGEMENT OF CYTS AND PSEUDOCYSTS COMPLICATING CHRONIC-PANCREATITIS - A RETROSPECTIVE STUDY OF 143 PATIENTS

One hundred and forty-three patients presenting with 170 cysts and Pse udocysts complicating chronic pancreatitis were followed between 1980 and 1990. Thirteen patients were managed conservatively and pseudocyst s spontaneously disappeared in 11 patients. Cysts were small (average 28 mm), often communicating with the ductal system without dilatation of the main pancreatic duct. Percutaneous puncture was performed in 47 patients with a low morbidity rate (5 %) but a high rate of recurrenc e (57 %). Thirteen of 39 patients (33 %) who underwent percutaneous pu nCtUre as initial treatment did not require further therapy. Communica tion of pancreatic cysts with the ductal system was associated with po orer results after percutaneous puncture. Percutaneous drainage was pe rformed in 9 patients with a low morbidity rate (12 %). The mean durat ion of drainage was 10. 4 days. Five patents were definitively cured. Seventy-eight endoscopic cystoenterostomies were performed in 71 patie nts. Complications occurred in 12 patients (15.3 %) and one patient di ed (1.3 %). Endoscopic cystoenterostomy was effective in 39 of 54 pati ents initially treated with this technique (72.2 %). Sixty-three patie nts underwent surgical management, principally internal drainage (83 % ), with a morbidity rate of 13.2 % and a mortalitY rate of 1.3 %. Twen ty-one of the 29 patients (72 %) who underwent surgery as initial trea tment did not require further therapy. Endoscopic cystoenterostomy is an efficient treatment of cysts and pseudocysts complicating CP when a natomical conditions are favorable. Percutaneous drainage also appears to be a satisfactory treatment modality. Surgery should be considered in cases Of failure or technical impossibility of endoscopic or percu taneous approaches.