PERCUTANEOUS CYSTOGASTROSTOMY FOR TREATMENT OF PANCREATIC PSEUDOCYSTS

Cystogastrostomy or cystojejunostomy at open operation has been the us ual treatment for symptomatic pancreatic pseudocyst. The aim of this s tudy was to assess prospectively the results of percutaneous cystogast rostomy (PCG) for the treatment of symptomatic pseudocysts. The techni que of PCG comprised initially of drainage of the pseudocyst with a 10 Fr percutaneous, transgastric catheter. This initial drainage cathete r had two components; the first, between the pseudocyst and the stomac h, drained the pseudocyst and the second, between the stomach and exte rior, acted as a percutaneous gastrostomy. The initial drain was left in situ for 14 days, at which time it was exchanged percutaneously for the definitive PCG; a double ended Mallecot type catheter that draine d between the pseudocyst and the stomach. The latter catheter was left in situ until there was no residual pseudocyst demonstrated on comput erized tomography scan and was removed endoscopically. Eleven patients with large (> 6 cm), symptomatic pseudocysts have been treated with P CG. All patients were treated successfully without the need for surgic al intervention. The median time to radiological resolution was 24 day s. There were four episodes of sepsis, two related to central venous l ine infections and two related to catheter blockage. Percutaneous cyst ogastrostomy blockage was managed by either replacing the initial drai n or inserting a second catheter. The median follow up after successfu l treatment was 9 months (range 2-17). There were no symptomatic recur rences and one small (2 cm) asymptomatic recurrent pseudocyst. This pr eliminary experience with PCG demonstrates the efficacy of this proced ure for treating symptomatic pancreatic pseudocysts.