Two Stage Approach Best for Treating Pancreatic Pseudocysts

A new study suggests that using a two-step approach is preferable in the treatment of a huge pancreatic pseudocyst.

Researchers at Tianjin Nankai Hospital (China), the General Hospital of Chinese People's Liberation Army (PLAGH; Beijing; China), and other institutions conducted a prospective, randomized trial with long-term follow-up to compare two management strategies of huge pancreatic pseudocysts. The first is a single-step endoscopic ultrasonography-guided puncture through the stomach to insert a double-pigtail stent to drain the pseudocyst; the second, two-step method combines the single-step method with a nasocystic drain.

Between January 2007 and December 2011, 47 patients were randomized into either a single-step or a two-step treatment protocol. The results showed significant differences in the infection rates (56.52% versus 20.83%), average days of hospitalization (mean 22.96 days versus 10.38 days), postoperative hospital stay (mean 15.31 days versus 7.21 days), and the disappearance time of the pseudocyst (mean 14.10 weeks versus 11.70 weeks) between the two groups, respectively. There was, however, no significant difference in the pseudocyst recurrence rate. The study was published in May 2015 issue of Pancreas.
“The preferred treatment of a huge pancreatic pseudocyst is a combined endoscopic ultrasonography method using two double-pigtail stents and a nasocystic drain,” concluded lead author Haicheng Yuan, MD, of the department of minimally invasive surgery at Tianjin Nankai Hospital, and colleagues.

Pancreatic pseudocysts are a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen; they are usually complications of pancreatitis. While an unsymptomatic small pseudocyst may be managed conservatively, larger ones will need some form of surgical treatment. This usually involves an anastomosis between the cyst and an adjacent intestinal organ, such as the stomach or intestine, thus allowing the cyst to drain. The type of surgical procedure depends on the location of the cyst.

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Tianjin Nankai Hospital
General Hospital of Chinese People's Liberation Army