Transduodenal endoscopic drainage of pancreatic pseudocysts and peripancreatic collection

: Until recently, the treatment of pancreatic pseudocysts was mainly surgical. However, two non-surgical invasive approaches are now possible: percutaneous aspiration under ultrasonic or CT monitoring and endoscopic drainage. PURPOSE--To report the result obtained using endoscopic drainage of pancreatic pseudocysts. METHODS--11 consecutive patients admitted with pancreatic pseudocyst had chronic pancreatitis and 1 patient had a well defined paraduodenal collection originated from acute necrotising pancreatitis. Endoscopic cystoduodenostomy was performed in the area of close contact with the digestive wall. A standard Olympus duodenoscope was used to reach the bulging wall and to allow the diatermic fistula. RESULTS--The success rate was 91.7%. Hemorrhage occurred in 1 patient (8.3%) controlled without blood transfusion. Endoscopic cystoduodenostomy was the definitive treatment in 10 patients 36 months after the procedure. One patient underwent gastrojejunostomy after 14 months for duodenal obstruction following relapsing pancreatitis. There was no relapsing cyst. There was no death following the endoscopic procedure. CONCLUSION--the endoscopic cystoduodenostomy constitutes an alternative procedure for the drainage of paraduodenal pseudocysts whenever restricted to the precise morphological indication of paraintestinal pseudocyst bulging into the duodenal lumen.