Clinical Outcomes and Safety of Endoscopic Transpapillary Pancreatic Duct Drainage for Pancreatic Pseudocysts: A Single-Center Tertiary Study

Aims Pancreatic pseudocysts with pancreatic duct abnormalities pose a therapeutic challenge, for which endoscopic retrograde cholangiopancreatography (ERCP) transpapillary drainage offers a minimally invasive solution. This study aimed to evaluate the clinical outcomes and safety in patients with pancreatic pseudocysts treated with primary ERCP transpapillary pancreatic duct drainage [1].

Methods This single-center retrospective analysis included all consecutive patients with pancreatic pseudocysts who underwent ERCP transpapillary drainage at Semmelweis University from July 28, 2023, to October 17, 2024. Procedures were conducted by ERCP experts with over 10 years of experience following prophylaxis against post-ERCP pancreatitis using rectal indomethacin and intravenous Ringer lactate. Baseline characteristics, procedural details, and follow-up data were collected, with adverse events graded via the AGREE classification. Clinical outcomes, adverse events, and event-free follow-up duration were assessed through outpatient visits and phone consultations for symptomatic cases. Results are presented as proportions with 95% confidence intervals (CIs) or means with standard deviations (SD).

Results A total of 14 ERCP transpapillary drainage procedures were performed for pancreatic pseudocysts in 12 patients (64% female, mean age 62.8, SD 14.5). The primary indication was pseudocyst progression (n=12, 86%), followed by icterus and/or cholangitis (n=4, 26%). The mean pseudocyst size was 62.5 mm AP (SD 40.5), 43.2 mm LL (SD 27.4), and 65.9 mm CC (SD 28.0), with varied locations. The procedural success rate was 64.3% (CI: 35.7%-85.7%), with failure mainly due to Vater papilla cannulation difficulties; failed cases were either followed up, underwent re-ERCP, or EUS-guided gastrocystostomy. Stent selection, based on pancreatography or difficulty in pancreas duct cannulation, ranged from 4 to 7 Fr in width and 5 to 11 cm in length. Among successful ERCPs, amylase and lipase levels decreased by a mean of 396.6 (SD 80.7) and 441.0 (SD 159.3), respectively, at 7-day follow-up. One AGREE Grade IIIa adverse event, requiring intra-procedural intervention, resolved without further treatment. The mean procedure time was 34.2 minutes (SD 13.6). During follow-up, pseudocyst regression was observed in five cases (one with complete resolution), one case required EUS-guided gastrocystostomy, and four cases are pending follow-up. No deaths occurred, though one patient required ICU treatment for multi-organ failure due to pancreatitis.

Conclusions ERCP transpapillary drainage offers moderate success for pancreatic pseudocysts, effectively reducing symptoms and enzyme levels in successful cases, with EUS-guided options available for challenging cases.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Lin H, Zhan XB, Jin ZD, Zou DW, Li ZS.. Prognostic factors for successful endoscopic transpapillary drainage of pancreatic pseudocysts. Dig Dis Sci 2014; 59 (2): 459-464