Success and Safety of Plastic Stent for Endoscopic Ultrasound Guided Pancreatic Pseudocyst Drainage - A Tertiary Single Centre Experience

Muhammad Bilal  Khattak; Zoya Ali  Khan; Uzair Ali  Khan; Rao Saad  Ali Khan; Khawar  Shabbir; Qurat-ul-Ainy  Chauhadry

doi:10.51253/pafmj.v76iSUPPL-5.11042

Authors

Muhammad Bilal Khattak Department of Gastroenterology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Zoya Ali Khan Research Assistant LGS Defence, Phase 1 Lahore Pakistan
Uzair Ali Khan Research Assistant the Downtown School, Seattle USA
Rao Saad Ali Khan Department of Gastroenterology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Khawar Shabbir Department of Gastroenterology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Qurat-ul-Ainy Chauhadry Department of Gastroenterology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-5.11042

Keywords:

Endoscopic drainage, Pancreatic Pseudocyst, Pancreatic cyst

Abstract

Objective: To determine the success and safety of plastic stent for endoscopic ultrasound (EUS) guided pancreatic pseudocyst (PP) drainage.

Study design: Quasi-experimental study

Place and duration: Pak-Emirates Military Hospital Rawalpindi, Pakistan from Jan 2018 to Jan 2021

Methodology: This study was conducted on seventy three participants with 20-80 years age, both genders, and symptomatic PP. Cases having small asymptomatic PP (<5cm), neoplastic cysts, multiloculated pseudocysts, coagulation profile derangement were excluded. EUS -guided drainage of PP was done. Success and safety of the procedure and post procedure compression related problems (PPCRP) were recorded at 24 hours, and at 4, 8, 12 and 24 weeks. Chi-square test was used to determine the association of PPCRP with biochemical and cytological parameters.

Results: The mean age was 45.38±12.79 years and 44 (60.27%) were males. In all participants, there was a 50.00% regression in cyst size at 4, 8, 12, and 24 weeks. Significant factors affecting PPCRP at 8 weeks were complicated pancreatic pseudocysts (PP), cystic haemorrhage, portal hypertension (on CT), and cystic location (on EUS). At 8 weeks, no resolution of compression-related problems was found in cases of complicated cysts (0%), and the results were statistically significant (p<0.001). The highest resolution in compression-related problems at 8 weeks was found when the cyst was located in the head (n=19, 61.29%) followed by the ..

Conclusion: Endoscopic ultrasound guided drainage of PP is an effective treatment modality having 50% regression in size after one month in all patients.

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References

MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62(1):102-111.

https://doi.org/10.1136/gutjnl-2012-302779

2. Tan JH, Chin W, Shaikh AL, Zheng S. Pancreatic pseudocyst: Dilemma of its recent management. Exp Ther Med 2021;21(2):159. https://doi.org/10.3892/etm.2020.9590

3. Jo S, Song S. Pancreatitis, panniculitis, and polyarthritis syndrome caused by pancreatic pseudocyst: A case report. World J Clin Cases 2019;7(18):2808-–2814.

https://doi.org/10.12998/wjcc.v7.i18.2808

4. Farias GF, Bernardo WM, De Moura DT, Guedes HG, Brunaldi VO, Visconti TAdC, et al. Endoscopic versus surgical treatment for pancreatic pseudocysts: Systematic review and meta-analysis. Med 2019;98(8):e14255.

https://doi.org/10.1097/md.0000000000014255

5. Tan J-h, Zhou L, Cao R-c, Zhang G-w. Identification of risk factors for pancreatic pseudocysts formation, intervention and recurrence: a 15-year retrospective analysis in a tertiary hospital in China. BMC Gastroenterol 2018;18(1):1-9.

https://doi.org/10.1186/s12876-018-0874-z

6. Udeshika W, Herath H, Dassanayake S, Pahalagamage S, Kulatunga A. A case report of giant pancreatic pseudocyst following acute pancreatitis: experience with endoscopic internal drainage. BMC Res Notes 2018;11(1):1-9.

https://doi.org/10.1186/s13104-018-3375-9

7. Agalianos C, Passas I, Sideris I, Davides D, Dervenis C. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol 2018;3:18-23.

https://doi.org/10.21037/tgh.2018.03.03

8. Zerem E, Hauser G, Loga-Zec S, Kunosić S, Jovanović P, Crnkić D. Minimally invasive treatment of pancreatic pseudocysts. World J Gastroenterol 2015;21(22):6850-6860.

https://doi.org/10.3748/wjg.v21.i22.6850

9. Panamonta N, Ngamruengphong S, Kijsirichareanchai K, Nugent K, Rakvit A. Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts. Eur J Gastroenterol Hepatol 2012;24(12):1355-1362.

https://doi.org/10.1097/meg.0b013e32835871eb

10. Pausawasdi N, Rugivarodom M, Rujirachun P, Charatchareonwitthaya P, Chantarojanasiri T, Sirivatanauksorn Y. Effectiveness and safety of a single 7-french plastic stent for endoscopic ultrasound-guided pancreatic pseudocyst drainage and long-term follow-up outcomes. J Med Ultrasound 2021;29(4):250–257.

https://doi.org/10.4103/jmu.jmu_148_20

11. Ng PY, Rasmussen DN, Vilmann P, Hassan H, Gheorman V, Burtea D, et al. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts: medium-term assessment of outcomes and complications. Endosc Ultrasound 2013;2(4):199–203.

https://doi.org/10.4103/2303-9027.121245

12. Sousa GBd, Machado RS, Nakao FS, Libera ED. Efficacy and safety of endoscopic ultrasound-guided drainage of pancreatic pseudocysts using double-pigtail plastic stents: A single tertiary center experience. Clinics 2021;76: e2701.

https://doi.org/10.6061/clinics/2021/e2701

13. Park D, Lee S, Moon S-H, Choi S, Jung S, Seo D, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 2009;41(10):842-848.

https://doi.org/10.1055/s-0029-1215133

14. Hammad T, Khan MA, Alastal Y, Lee W, Nawras A, Ismail MK, et al. Efficacy and safety of lumen-apposing metal stents in management of pancreatic fluid collections: are they better than plastic stents? A systematic review and meta-analysis. Dig Dis Sci 2018;63(2):289-301.

https://doi.org/10.1007/s10620-017-4851-0

15. Nelsen EM, Johnson EA, Walker AJ, Pfau P, Gopal DV. Endoscopic ultrasound-guided pancreatic pseudocyst cystogastrostomy using a novel self-expandable metal stent with antimigration system: A case series. Endoscop Ultrasound 2015;4(3):229.

https://doi.org/10.4103/2303-9027.163007

16. Varadarajulu S, Lopes TL, Wilcox CM, Drelichman ER, Kilgore ML, Christein JD. EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc 2008;68(4):649-655.

https://doi.org/10.1016/j.gie.2008.02.057

17. Lopes CV, Pesenti C, Bories E. Endoscopic-ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts and abscesses. Scand J Gastroenterol 2007;42:524–529.

https://doi.org/10.1080/00365520601065093

18. Falde S, Kamboj AK, Dines V. 1345 pancreatic pseudocyst leading to gastric outlet obstruction: a hard diagnosis to swallow. J Am Coll Gastroenterol 2019;114: S744-S745.

https://doi.org/10.14309/01.ajg.0000594908.70639.1d

19. Khanna A, Tiwary SK, Kumar P. Pancreatic pseudocyst: therapeutic dilemma. Int J Inflam 2012;2012:279476.

https://doi.org/10.1155/2012/279476