Endoscopic drainage of pancreatic pseudocysts: Long-term outcome and procedural factors associated with safe and successful treatment

Background and Study Aims: Endoscopic drainage is a widely used treatment modality for pancreatic pseudocysts and has challenged more traditional drainage techniques. This retrospective study evaluates the short-term and long-term results with this technique and aims to identify procedural modifications that may improve its safety and efficacy. Patients and Methods: All consecutive patients who underwent endoscopic drainage of pancreatic pseudocysts in our hospital between 1983 and 2000 were included in the study. The patients' charts were reviewed, and long-term follow-up data were obtained by written questionnaires sent to the patients at the end of the follow-up period in November 2002. Results: A total of 92 patients were included (66 men, 26 women; median age 49 years). The technical success rate of the drainage procedure was 97% and the mortality rate was 1%. Complications occurred in 31 patients (34%), eight of which (9%) were major and required surgery: hemorrhage in four cases (three of which were caused by erosion of a straight endoprosthesis through the cyst wall), secondary infection in three, and perforation in one. During a median follow-up period of 43 months, 10 patients (11%) underwent additional (nonendoscopic) treatment for a persistent cyst and five (5%) for a recurrent cyst. Overall, endoscopic drainage was successful in 65 patients (71%). Conclusions: Endoscopic drainage is an effective treatment for pancreatic pseudocysts and offers a definitive solution in almost three-quarters of the cases. The majority of major complications might have been prevented by using pigtail stents instead of straight stents and by taking a more aggressive approach to the prevention and treatment of secondary cyst infection.