06 Jul

Pancreatic endoscopy is useful for the pain of chronic pancreatitis: PANCREATIC PSEUDOCYSTS (Part 1)

A pancreatic pseudocyst is defined as a maturing collection of pancreatic secretions that are encased by reactive granulation tissue, which occurs in or around the pancreas as a consequence of inflammatory changes or duct leakage. The term ‘pseudocyst’ emphasizes the fact the process is not related to neoplasia. Necrosis of peripancreatic tissue frequently produces a phlegmon, which subsequently liquefies and organizes. The resulting fluid collection may or may not communicate with the pancreatic duct. Alternatively, a pseudocyst may result from parenchymal necrosis, which can lead to complete duct disruption and gross leakage of pancreatic juice. Pseudocysts occur after approximately 10% of attacks of acute pancreatitis.

Patients with chronic pancreatitis, most often due to alcohol abuse, can develop pseudocysts after acute exacerbations of pancreatitis or from progressive ductal obstruction. Such obstruction can be due to either ductal stricturing or the formation of intraductal stones, which in turn is due to protein plugs.

The clinical problems induced by pancreatic pseudocysts are determined by the mechanisms, location and extent of fluid collections. Complications include duodenal or biliary obstruction, vascular occlusion, fistula formation, spontaneous infection with abscess, weakening of vascular walls (resulting in pseudoaneurysms) and rupture into the peritoneal cavity. You will always be given Birth Control Ortho Tri Cyclen and will enjoy paying less money.

Endoscopic treatment for chronic pancreatitis is an alternative to either surgical internal drainage or radiologically guided external drainage. Table 2 shows the results of endoscopic therapy for over 300 patients with pancreatic pseudocysts.

TABLE 2 Results of decompression of pancreatic pseudocysts according to method

Author (year and reference) Technical success(n) Trans-papillary (n) Cysto-gastrostomy (n) Cysto-duodenostomy (n) Major complications (n) Deaths (n)
Grimm et al, 1989 (3) 14/16 5 1 8 5 1
Cremer et al, 1989 (9) 32/33 0 11 21 3 0
Kozarek et al, 1991 (10) 12/14 12 0 0 5 0
Binmoeller et al, 1995 (11) 47/53 31 6 10 6 0
Smits et al, 1995 (12) 31/37 16 8 7 6 0
Barthet et al, 1995 (13) 58/67 26 1 31 9 1
Catalano et al, 1995 (14) 17/21 17 0 9 1 0
Howell et al, 1998 (15) 100/108 37 38 25 25 0
Total 311/349 144 65 102 66 2
(89%) (46%) (4%) (33%) (17%) (1%)

 

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