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DOI: 10.1055/s-2003-43439
© Georg Thieme Verlag Stuttgart · New York
Endoskopische Drainage von symptomatischen Pankreaspseudozysten
Eine effiziente und sichere Therapie in der klinischen Routine?Endoscopic drainage of symptomatic pancreatic pseudocystsAn efficacious and safe routine clinical treatment?Publication History
eingereicht: 14.4.2003
akzeptiert: 17.7.2003
Publication Date:
06 November 2003 (online)
Hintergrund und Fragestellung: Klinische Studien haben für die endoskopisch-interventionelle Therapie von Pankreaspseudozysten hervorragende Erfolgsraten bei niedriger Komplikationsrate gezeigt. Ob diese guten Resultate auch in der klinischen Routine gastroenterologischer Zentren erreichbar sind, ist nicht bekannt.
Patienten und Methodik: Die Ergebnisse der endoskopischen Pseudozystentherapie bei 21 Patienten (15 Männer, 6 Frauen) im Alter von 40-81 Jahren aus den Jahren 1997-2002 wurden ausgewertet. Dies schloss eine aktuelle Nachuntersuchung ein.
Ergebnisse: Vergleichbar mit vorliegenden Studienergebnissen zeigte sich ein initialer symptomatischer Erfolg bei 18/21 Patienten und ein symptomatisches Rezidiv bei nur zwei Patienten. Die eingriffsbedingten Komplikationen konnten konservativ beherrscht werden.
Folgerung: Die Ergebnisse klinischer Studien einer endoskopisch-interventionellen Pseudozystentherapie sind in einem gastroenterologischen Zentrum in der klinischen Routine erreichbar und lassen ein chirurgisches Vorgehen für die Fälle, bei denen der endoskopische Erfolg ausbleibt, in den Hintergrund treten.
Background and objective: Clinical studies have demonstrated excellent success and low complication rates of endoscopic therapy of pancreatic pseudocysts. But it is not known, if these results can be reached in gastroenterological centers outside clinical studies.
Patients and methods: We investigated the outcome of endoscopic therapy in 21 patients (15male, 6 female, age 40 - 81) with pancreatic pseudocysts treated in our clinic between 1997 and 2002. A follow-up examination was included.
Results: Similar to the results of reported clinical studies the initial clinical success rate was 18/21 with symptomatic recurrences in two patients. All therapy-induced complications were successfully treated conservatively.
Conclusion: Excellent results of endoscopic therapy of pancreatic pseudocysts can be reached in a gastroenterological center. Surgical treatment can be reserved for cases, when endoscopic therapy fails.
Literatur
- 1 Adams D B, Anderson M C. Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst. Ann Surg. 1992; 215 571-576
- 2 Barthet M, Bugallo M, Moreira L S, Bastid C, Sastre B, Sahel J. Management of cysts and pseudocysts complicating chronic pancreatitis: A retrospective study of 143 patients. Gastroenterol Clin Biol. 1993; 17 270-276
- 3 Barthet M, Sahel J, Bodiou-Bertei C, Bernard J P. Endoscopic transpapillary drainage of pancreatic pseudocysts. Gastrointest Endosc. 1995; 42 208-213
- 4 Beckingham I J, Krige J E, Bornman P C, Terblanche J. Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol. 1999; 94 71-74
- 5 Bradley E L. Cysts and pseudocysts of the pancreas: Surgical aspects. Gastroenterology. 1985; 6 4151-4157
- 6 Bradley E L, Clements J L, Gonzalez A C. The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg. 1979; 137 135-41
- 7 Catalano M F, Geenen J E, Schmalz M J, Johnson G K, Dean R S, Hogan W J. Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis. Gastrointest Endosc. 1995; 42 214-218
- 8 Cremer M, Deviere J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience. Gastrointest Endosc. 1989; 35 1-9
- 9 De Palma G D, Galloro G, Puzziello A, Masone S, Persico G. Endoscopic drainage of pancreatic pseudocysts: a long-term follow-up study of 49 patients. Hepatogastroenterology. 2002; 49 1113-1115
- 10 Giovannini M, Bernardini D, Seitz J F. Cystogastrotomy entirely performed under endosonography guidance for pancreatic pseudocyst: results in six patients. Gastrointest Endosc. 1998; 48 200-203
- 11 Giovannini M, Pesenti C, Rolland A L. et al . Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope. Endoscopy. 2000; 32 255-259
- 12 Gouyon B, Levy P, Ruszniewski P. et al . Predictive factors in outcome of pseudocysts complicating alcoholic chronic pancreatitis. Gut. 1997; 41 821-826
- 13 Heyder N, Gunter E, Hahn E G. Endoscopic-sonographic control of cystogastric catheter drainage of pancreatogenic fluid collections. Z Gastroenterol. 1992; 30 553-557
- 14 Huibregtse K, Schneider B, Vrij A A, Tytgat G N. Endoscopic pancreatic drainage in chronic pancreatitis. Gastrointest Endosc. 1988; 34 9-15
- 15 Kozarek R A, Brayko C M, Harlan J, Sanowski R A, Cintora I, Kovac A. Endoscopic drainage of pancreatic pseudocysts. Gastrointest Endosc. 1985; 31 322-327
- 16 Lo S K, Rowe A. Endoscopic management of pancreatic pseudocysts. Gastroenterologist. 1997; 5 10-25
- 17 O’Malley V P, Cannon J P, Postier R G. Pancreatic pseudocysts: cause, therapy, and results. Am J Surg. 1985; 150 680-682
- 18 Pitchumoni C S, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed?. Gastroenterol Clin North Am. 1999; 28 615-39
- 19 Rapp K, Zundler J, Walker S. Nicht-operative Verfahren zur Behandlung von Pankreaspseudozysten. Dtsch Med Wochenschr. 1995; 120 1129-1132
- 20 Seifert H, Faust D, Schmitt T. et al . Transmural drainage of cystic peripancreatic lesions with a new large-channel echo endoscope. Endoscopy. 2001; 33 1022-1026
- 21 Smits M E, Rauws E A, Tytgat G N, Huibregtse K. The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastrointest Endosc. 1995; 42 202-207
- 22 Van Sonnenberg E, Wittich G R, Casola G. et al . Percutaneous drainage of infected and non-infected pancreatic pseudocysts: experience in 101 cases. Radiology. 1989; 170 757-761
- 23 Vitale G C, Lawhon J C, Larson G M, Harrell G J, Reed D N, MacLeod S. Endoscopic drainage of the pancreatic pseudocyst. Surgery. 1999; 126 616-621
- 24 Yeo C J, Sarr M G. Cystic and pseudocystic diseases of the pancreas. Curr Probl Surg. 1994; 31 167-243
Prof. Dr. med. Jürgen F. Riemann
Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH
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