Sharma S S, Bhargawa N, Govil A
Department of Gastroenterology, SMS Medical College, Jaipur, India.
Endoscopy. 2002 Mar;34(3):203-7. doi: 10.1055/s-2002-20292.
No studies with real long-term follow-up after endoscopic drainage of pancreatic pseudocysts are available. The present study was undertaken to investigate the long-term outcome of endoscopic management of pancreatic pseudocyst with a minimum follow-up of 2 years.
A total of 38 consecutive patients with pancreatic pseudocyst underwent endoscopic cystogastrostomy (n = 27), endoscopic cystoduodenostomy (n = 6) and transpapillary drainage (n = 5). Patients were monitored at 1 and 3 months after drainage, and finally between 24 and 80 months. Upper gastrointestinal endoscopy was done at 1 and 3 months after drainage while ultrasound was done at 3 months and at the end of follow-up. Endoscopic retrograde cholangiopancreatography (ERCP) was only done before cyst drainage if no cyst bulge was visible in the stomach or duodenum or if obstructive jaundice was present.
Biliary pancreatitis was responsible for the pseudocyst in 19 cases while the remaining occurrences were caused by alcohol (n = 12) and trauma (n = 7). All forms of endoscopic drainage were effective in treating pancreatic pseudocyst and there was complete disappearance of the cyst within 3 months of drainage, irrespective of cause. Over a mean follow-up of 44.23 months (24 - 80 months). Three patients had symptomatic recurrences while three had asymptomatic recurrences; all had alcohol-induced pancreatitis. No recurrences were seen in the biliary pancreatitis and trauma group. All symptomatic recurrences were successfully managed with endoscopic cystogastrostomy and stenting. A massive bleed in one patient required surgery while stent block and cyst infection in three patients and perforation in one patient were managed conservatively. ERCP was done before cyst drainage in eight patients because there was no visible bulge into the stomach or duodenum (n = 5), or because obstructive jaundice was present (n = 3). In five patients ERCP revealed cyst duct communication. All these patients were managed by transpapillary drainage and there was only one asymptomatic recurrence in this group.
Endoscopic management of pancreatic pseudocyst is quite an effective and safe mode of treatment in experienced hands. ERCP before the procedure is only required when the cyst does not bulge into gut lumen, for a decision about the feasibility of transpancreatic drainage. On long-term follow-up, recurrences were seen only in the alcoholic pancreatitis group. In the biliary pancreatitis group, no recurrences were seen after cholecystectomy and removal of common bile duct (CBD) stones if present. No recurrences were seen in the trauma group.
目前尚无关于胰腺假性囊肿内镜引流术后真正长期随访的研究。本研究旨在探讨胰腺假性囊肿内镜治疗的长期疗效，随访时间至少为2年。
连续38例胰腺假性囊肿患者接受了内镜下囊肿胃造口术（n = 27）、内镜下囊肿十二指肠造口术（n = 6）和经乳头引流术（n = 5）。在引流后1个月和3个月对患者进行监测，最终随访时间为24至80个月。引流后1个月和3个月进行上消化道内镜检查，3个月及随访结束时进行超声检查。仅在胃或十二指肠未见囊肿隆起或存在梗阻性黄疸时，在囊肿引流前进行内镜逆行胰胆管造影（ERCP）。
19例假性囊肿由胆源性胰腺炎引起，其余病例由酒精（n = 12）和外伤（n = 7）引起。所有形式的内镜引流对治疗胰腺假性囊肿均有效，无论病因如何，囊肿在引流后3个月内均完全消失。平均随访44.23个月（24 - 80个月）。3例患者出现症状复发，3例患者出现无症状复发；所有复发均由酒精性胰腺炎引起。胆源性胰腺炎和外伤组未见复发。所有症状性复发均通过内镜下囊肿胃造口术和支架置入成功处理。1例患者发生大出血需要手术治疗，3例患者的支架堵塞、囊肿感染及1例患者的穿孔均保守治疗。8例患者在囊肿引流前进行了ERCP，原因是胃或十二指肠未见明显隆起（n = 5）或存在梗阻性黄疸（n = 3）。5例患者ERCP显示囊肿与胆管相通。所有这些患者均采用经乳头引流治疗，该组仅1例无症状复发。
在经验丰富的医生手中，内镜治疗胰腺假性囊肿是一种相当有效且安全的治疗方式。仅在囊肿未向肠腔内隆起时，术前进行ERCP以决定经胰腺引流的可行性。长期随访发现，仅酒精性胰腺炎组出现复发。在胆源性胰腺炎组，胆囊切除及取出胆总管结石（如有）后未见复发。外伤组未见复发。
