Endoscopic minimal invasive methods for drainage of pancreatic cysts and abscesses: 3-year results from a single centre

Objective of the study: As an alternative to open surgery laparoscopic, endoscopic and interventional radiology has been developed to treat complications of acute pancreatitis. These methods carry less morbidity and mortality than open surgical treatment.

Methods and procedures: During a 3 year period 22 of 478 patients hospitalized with the diagnosis acute pancreatitis at the Department of Surgery, South Älvsborg Hospital, Borås, Sweden developed abscesses or symptomatic cysts.

NOTES-technique: With EUS the abscess/cyst was identified and punctured. Over a guidewire the puncture hole was dilated with a 20 mm CRE-balloon. A therapeutic large channel gastroscope was introduced into the cyst/abscess over the wire for cleaning and necrosectomy. Four 10 F pigtail stents were left in place between the cyst and gastric lumen to secure drainage.

Percutaneous endoscopic technique: The abscess was punctured with the help of external US and a guidewire was introduced. The chanel was dilated with a 20 mm CRE-balloon and a therapeutic large channel gastroscope was introduced over the wire into the cyst/abscess for cleaning and necrosectomy. A 24 F drainage was left in place for drainage and further rinsing.

Results: Out of the 22 patients 10 with abscesses and 7 with cysts were treated with NOTES-technique and 2 were treated with percutaneous endoscopic technique. Two patients were laparotomized due to spontaneous perforation of the abscess into the transverse colon. One of these patients were later drained with NOTES-techniqe duo to a secondary pseudocyst. One patient was excluded duo to pancreatic cancer. Abscesses needed in median 1,5 (1–7) interventions while percutaneous drainage needed a median of 3 interventions (2–4). The patients were followed by CT-scans. All abscesses/cysts drained with minimally invasive techniques healed without need of surgery.

Complications: One patient died later due to heart failure, one draine migrated into the cyst and was not possible to remove.

Conclusions: Pancreatic abscesses and cysts can safley be drained with endoscopic techniques (NOTES or percutaneous) with low morbidity and mortality.