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2015 ; 94
(24
): e960
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Classification and Management of Pancreatic Pseudocysts
#MMPMID26091462
Pan G
; Wan MH
; Xie KL
; Li W
; Hu WM
; Liu XB
; Tang WF
; Wu H
Medicine (Baltimore)
2015[Jun]; 94
(24
): e960
PMID26091462
show ga
This article aims to elucidate the classification of and optimal treatment for
pancreatic pseudocysts. Various approaches, including endoscopic drainage,
percutaneous drainage, and open surgery, have been employed for the management of
pancreatic pseudocysts. However, no scientific classification of pancreatic
pseudocysts has been devised, which could assist in the selection of optimal
therapy. We evaluated the treatment modalities used in 893 patients diagnosed
with pancreatic pseudocysts according to the revision of the Atlanta
classification in our department between 2001 and 2010. All the pancreatic
pseudocysts have course of disease >4 weeks and have mature cysts wall detected
by computed tomography or transabdominal ultrasonography. Endoscopic drainage,
percutaneous drainage, or open surgery was selected on the basis of the
pseudocyst characteristics. Clinical data and patient outcomes were reviewed.
Among the 893 patients, 13 (1.5%) had percutaneous drainage. Eighty-three (9%)
had type I pancreatic pseudocysts and were treated with observation. Ten patients
(1%) had type II pseudocysts and underwent the Whipple procedure or resection of
the pancreatic body and tail. Forty-six patients (5.2%) had type III pseudocysts:
44 (4.9%) underwent surgical internal drainage and 2 (0.2%) underwent endoscopic
drainage. Five hundred six patients (56.7%) had type IV pseudocysts: 297 (33.3%)
underwent surgical internal drainage and 209 (23.4%) underwent endoscopic
drainage. Finally, 235 patients (26.3%) had type V pseudocysts: 36 (4%) underwent
distal pancreatectomy or splenectomy and 199 (22.3%) underwent endoscopic
drainage. A new classification system was devised, based on the size, anatomical
location, and clinical manifestations of the pancreatic pseudocyst along with the
relationship between the pseudocyst and the pancreatic duct. Different
therapeutic strategies could be considered based on this classification. When
clinically feasible, endoscopic drainage should be considered the optimal
management strategy for pancreatic pseudocysts.
|Digestive System Surgical Procedures/methods
[MESH]
free
free
free
