Publication:

A prospective study on surgical versus endoscopic cystoenterostomy

Background The aim of the present study was to compare endoscopic and surgical modalities in the treatment of pancreatic pseudocysts. Comparisons were based on clinical success, complication rate, recurrence and hospital stay.

Methods This is a prospective comparative study, enrolling 24 patients, 13 in surgical group and 11 in endoscopic group. The duration of study was from December 2013 to September 2015. The minimum follow up was for atlas 6 months.

Results 13 (54%) of cases were managed surgically, 11 (46%) of cases were treated endoscopically. The clinical success of the endoscopic group was 72.7% versus 100% for the surgical group (p=0.216), with a complication rate of 36.4% and 15.3%, respectively (p= 0.659). The hospital stay was lower for the endoscopic group was 9.82 days compared with 12.08 days in the surgical group. The two recurrences found in the endoscopic group were associated with main pancreatic duct stricture and disconnected pancreatic duct. The duration to oral intake post procedure was lower in endoscopic group 4.36 days (p<0.001). 18.2% of patients in endoscopic group required conversion to open surgery.

Conclusions Non EUS guided cystoenterostomy has to be phased out. 1/3rd of patients undergoing endoscopic cystoenterostomy require more than 6 months of stent placement. In patients with disruption of the main pancreatic duct, endoscopic intervention is more successful when combined with transpapillary ductal stent placement.