Cystograstrostomy Guided by Endoscopic Ultrasound in the Treatment of Pancreatic Pseudocysts

Abstract

Introduction: The management of the pancreatic pseudocysts has recently benefited from less invasive technics, the most recent being the interventional echoendoscopy. The objective of this work is to evaluate the effectiveness and safety of the kystogastrotomy guided by the endoscopy in the treatment of the pancreatic pseudocysts.

Patients and Methods: This is a retrospective study from September 2010 to August 2015, made by the gastroenterology department of the military hospital of Rabat. All patients who benefited from an endoscopic drainage for symptomatic pseudocyst and bulging into the digestive lumen were included. The selected patients received a kystogatrotomy guided by the echoendoscopy using a linear echoendoscope with large operating canal and a cystotome. Two dual pig tail prostheses were then put in place. A clinical and echographic control was carried out systematically in all the patients 48 to 72 hours after the gesture and then every month until the convex resolution of the pancreatic collection. The withdrawal of the prostheses was carried out under endoscopy after a complete disappearance of the radiological image. Then the control was clinical and echographic all 3 months during one year then all 6 months during a year.

Results: During the period of study, 23 patients of average age 59±12 years old received a kystogastrotomy guided by the echoendoscopy. The sex-ratio was 0.64. The acute pseudocysts complicated the acute pancreatile in 20 patients, the surgery of the pancreas in 1 patient and traumatism in 2 patients. The average age of patients was 52.69 ± 12.85 years old. Two dual pig tail prostheses were then put in place in all patients. The rate of immediate technical success was 95.65% (n=22), the rate of immediate complication was 4.5% (n=1). The therapeutic success was 90.9% (n=21). Two patients presented a clinical recidivism due to a secondary infection treated by surgery. The rate of letality was 4.35% (n=1).

Conclusion: The kystogastrotomy guided by echoendoscopy seems to be an effective and safe approach in the treatment of the first intention of pancreatic pseudocysts.