To assess whether trans papillary drainage is the way to go for pseudocysts drainage complicating patients with chronic pancreatitis

Aims To assess whether trans papillary drainage is the way to go for pseudocysts complicating patients with chronic pancreatitis. With our previous experience we used the technique of no injecting contrast during ERP in case of leaks complicating chronic pancreatitis causing either pseudocysts, pleural effusions or ascites. Here we are presenting a retrospective analysis of our management of pseudocysts in chronic pancreatitis.

Methods We retrospectively analysed all cases of chronic pancreatitis having ascites, effusions and pseudocysts. We performed magnetic resonance cholangiopancreatography (MRCP) followed by therapeutic endoscopic retrograde pancreatography (ERP) without contrast. Results were observed confirming a leak from the MPD, possibility of wire crossing the leak or not and resolution of the pseudocysts. Patients with only pseudocysts were included in this analysis.

Results We performed ERP in 1522 patients from 2000 till date. Ductal disruptions noted in 509/1522 (33.44%) out of which pseudocyst was observed in 330 cases (64.83%). 311 patients (94.2%) experienced successful cannulation of PD. In 19 (5.8%) PD could not be cannulated. Non cannulated cases treated with EUS guided transmural drainage 14 (73.7%) and surgery 5 (26.3%). Of these 311, 24 (8.3%) had pancreas divisum and MPD was cannulated from minor papilla. Leak did not cross but stents put in cyst (236, 75.9%). Cyst resolution – 228 (96.6%). Cyst Not resolved 8 (3.4%). Leaks were crossed in 75 (24.1%); Cyst resolution 69 (92%). Cyst not resolved 6 (8%). Unresolved cysts 14 (4.5%) were treated with EUS Aspiration- 5 (35.7%), EUS Transmural drainage 8 (57.1%), Surgery -2 (14.2%).

Discussion: In chronic pancreatitis the cause of pseudocysts is ductal rupture and very minimal inflammation as compared to acute pancreatitis where the major cause is inflammation with ductal leak and necrosis of the pancreas. There is hardly any necrosis in chronic pancreatitis pseudocysts. Hence the management of both should be individualised. Transpapillary drainage in pseudocysts complicating chronic pancreatitis offers a less morbid and a simpler alternative to transmural drainage or surgery.

Conclusions Pseudocysts complicating chronic pancreatitis can be managed very effectively using transpapillary drainage in majority of cases and should be attempted before considering transmural or surgical drainage. It saves the patient significant morbidity.

Publication History

Article published online:
27 March 2025