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Background/Aims: Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs. Methods: A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs). Results: Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480). Conclusions: Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound (EUS)-guided transluminal drainage has become a first-line treatment modality for symptomatic pancreatic pseudocysts. Despite the increasing popularity of lumen-apposing metal stents (LAMSs), plastic stents may resolve non-necrotic fluid collections effectively with lower costs and no LAMS-specific adverse events. To date, there has been a paucity of data on the appropriate stent type in this setting. This trial aims to assess the non-inferiority of plastic stents to a LAMS for the initial EUS-guided drainage of pseudocysts. Methods: The WONDER-02 trial is a multicentre, open-label, non-inferiority, randomised controlled trial, which will enrol pancreatic pseudocyst patients requiring EUS-guided treatment in 26 centres in Japan. This trial plans to enrol 80 patients who will be randomised at a 1:1 ratio to receive either plastic stents or a LAMS (40 patients per arm). In the plastic stent group, EUS-guided drainage will be performed using two 7-Fr double pigtail stents. In the LAMS group, the treatment will be performed in the same way except for LAMS use. The step-up treatment will be performed via endoscopic and/or percutaneous procedures at the trial investigator's discretion. The primary endpoint is clinical success, which is defined as a decrease in a pseudocyst size to ≤ 2 cm and an improvement in inflammatory indicators (i.e. body temperature, white blood cell count, and serum C-reactive protein). Secondary endpoints include technical success, adverse events including mortality, pseudocyst recurrence, and medical costs. Discussion: The WONDER-02 trial will investigate the efficacy and safety of plastic stents compared to a LAMS in EUS-guided treatment of symptomatic pancreatic pseudocysts with a particular focus on the non-inferior efficacy of plastic stents. The findings will help establish a new treatment algorithm for this population. Trial registration: ClinicalTrials.gov NCT06133023 registered on 9 November 2023. UMIN000052647 registered on 30 October 2023. jRCT1032230444 registered on 7 November 2023. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pancreatic pseudocysts often arise as complications of pancreatitis and present unique challenges in clinical management, encompassing considerations for both technical aspects and financial implications. Before the advancements of invasive gastroenterology, pancreatic pseudocysts have been drained surgically for many years. Nowadays, we have less invasive techniques with higher efficiency and lower mortality rates, however, they remain cost-challenging for most countries. Materials and Methods: We present four patients (two males and two females) with pancreatic pseudocysts who underwent endoscopic ultrasound-guided transgastric drainage using plastic stents accompanied by a standard lavage protocol using a nasocystic catheter. Results: All four patients had successful outcomes, and a follow-up at 6 months revealed no traces of the pseudocysts or any significant long-term complications. One acute complication (arterial bleeding) and one late complication (stent migration) were observed. As the study aimed to present a cheaper option for draining pancreatic pseudocysts, we investigated and compared costs for the materials we utilized and those associated with lumen-apposing metal stents. Upon compiling the data, a notable advantage was evident in favour of our method. Conclusions: While EUS-guided drainage of pancreatic pseudocysts using lumen-apposing metal stents (LAMSs) represents a high-end strategy for treating pancreatic pseudocysts, our method demonstrates better cost-effectiveness without compromising efficacy. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocysts are surrounded by a non-epithelialized wall confined to the pancreas and localized to the pancreatic tissue or adjacent pancreatic cavity. In contrast, pancreatic cystic tumors occur less frequently than solid lesions and are often detected incidentally on imaging. Regarding the qualitative diagnosis of pancreatic pseudocysts, it is important to differentiate them from neoplastic cysts. We report the case of a 74-year-old woman with a giant hemorrhagic pancreatic pseudocyst and a suspected cystic pancreatic tumor, wherein distal pancreatectomy and splenectomy with lymph node dissection were performed. The patient was discharged 11 days postsurgery, with a good postoperative course. There are no reports of giant pancreatic pseudocysts larger than 10 cm with hematoma contents. The presumptive diagnosis of pseudocysts based on imaging alone may be difficult. Surgical resection is considered when it is difficult to distinguish a giant pancreatic pseudocyst from a cystic neoplasm. [ABSTRACT FROM AUTHOR]

Background Endoscopic ultrasound (EUS)-guided transmural drainage using double pigtail plastic stents (DPPS) has been routine for the treatment of peripancreatic fluid collections (PFC). Lumen-apposing metal stents (LAMS) have since their introduction been the preferred choice; however, their superiority has not been proven. The aim of this study was to compare the efficacy and safety of DPPS and LAMS. Methods This was a single-center, prospective study that included consecutive patients undergoing EUS-guided drainage between January 2010 and December 2020. The primary endpoints were technical success, clinical success and adverse event rate, while the secondary endpoints included symptomatic relief, length of hospital stay, and need for adjunct drainage. A subgroup analysis of walled-off necrosis (WON) was performed. Results A total of 89 patients (median age 56 years) underwent EUS-guided transmural drainage (DPPS: n=53; LAMS: n=36) because of a pseudocyst (n=37) or a WON (n=52). Both DPPS and LAMS had a 100% technical success rate and a comparable adverse event rate (4% vs. 6%, P=0.24). An equivalent efficacy was recorded for the drainage of PFC comparing DPPS and LAMS, and no significant statistical difference was recorded in clinical success (DPPS 60% vs. LAMS 61%, P=0.94) or the need for reintervention (DPPS 11% vs. LAMS 13%, P=0.72). Conclusions In this large, prospective study of EUS-guided drainage of peripancreatic fluid collections, LAMS and DPPS showed equivalent safety, technical success, clinical success and hospital stay. Both techniques were associated with a comparable need for complementary necrosectomy. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Pancreatic calculi (PC) or pancreatolithiasis refers to the presence of stones in the main pancreatic duct (MPD), side branches, or parenchyma of the pancreas. It is highly associated with chronic pancreatitis (CP), and is present in 50-90% of those patients. The stone formation can be attributed to a diversity of factors, all of them leading to obstruction in the duct, hypertension of its distal part, increased intraductal and parenchymal pressure, and inflammation, causing the standard symptom, epigastric pain. Immediate restoration of pancreatic secretion flow is of utmost importance and can be achieved with both endoscopic and surgical techniques. Endoscopic techniques include endoscopic retrograde cholangiopancreatography (ERCP) combined, if possible, with extracorporeal shock wave lithotripsy (ESWL), while surgical techniques consist of drainage and resection procedures. The choice of treatment for PC depends on the location, size, and number of stones, and the existence of other complications. Case Reports: We present 2 cases that were diagnosed with PC, in which clinical symptoms, laboratory results, and imaging examinations were different, suggesting the variety of manifestations pancreatolithiasis can cause. Each patient was treated differently, according to their clinical situation and the presence or absence of complications. Both patients were discharged and fully recovered. Conclusions: The management of pancreatolithiasis can be demanding in some cases, mostly when there are complications. The purpose of this case report is to indicate the importance of personalized treatment for each patient, as different approaches to the same medical condition should be easily identified and successfully treated. [ABSTRACT FROM AUTHOR]

Objective: Congenital defects/diseases Background: Duplication of the gastrointestinal tract is a rare congenital malformation that can develop in any part of the digestive tract. These duplications may be asymptomatic into adult age. Situs inversus totalis is a rare congenital anomaly characterized by a mirror transposition of thoracic and abdominal organs. We present a case of a pancreatic pseudocyst in a patient with a combination of situs inversus totalis and doubling of the esophagus, stomach, and first part of the duodenum. Case Report: A 64-year-old woman presented with epigastric pain. Abdominal computed tomography revealed a pancreatic pseudocyst and a previously identified duplication of the esophagus, stomach, and duodenum with situs inversus totalis. The patient underwent esophagogastroduodenoscopy (EGD) with endoscopic ultrasonography for pseudocyst drainage. During EGD, a bifurcation of the esophagus was found. Duplication of the esophagus, stomach, and first part of the duodenum was evident on further advancement. A week later, there was repeated filling of the pseudocyst with a liquid component, and the patient underwent cystogastrostomy with stenting. Five months after discharge, the stent was removed without complications. Conclusions: Duplication of the gastrointestinal tract and situs inversus totalis are very rare congenital malformations that require early diagnosis. While situs inversus totalis does not represent any medical disadvantage, physicians should be aware of abnormal anatomy before procedures to prepare specialists for this in case of the need for special techniques. Endoscopic treatment of pancreatic pseudocysts is safe and effective even in such rare cases. The use of endoscopic methods also minimizes intervention and decreases the length of the patients' stays in the hospital. [ABSTRACT FROM AUTHOR]

Background/Aims: The pancreatic pseudocyst (PP) is a type of fluid collection that typically develops as a delayed complication of acute pancreatitis. Drainage is indicated for symptomatic patients and/or associated complications, such as infection and bleeding. Drainage modalities include percutaneous, endoscopic, laparoscopic, and open drainage. This study aimed to assess trends in the utilization of different drainage modalities for treating PP from 2016 to 2020. The trends in mortality, mean length of hospital stay, and mean hospitalization costs were also assessed. Methods: The National Inpatient Sample database was used to obtain data. The variables were generated using International Classification of Diseases-10 diagnostic and procedural codes. Results: Endoscopic drainage was the most commonly used drainage modality in 2018-2020, with an increasing trend over time (385 procedures in 2018 to 515 in 2020; p=0.003). This is associated with a decrease in the use of other drainage modalities. A decrease in the hospitalization cost for PP requiring drainage was also noted (29,318 United States dollar [USD] in 2016 to 18,087 USD in 2020, p<0.001). Conclusions: Endoscopic drainage is becoming the most commonly used modality for the treatment of PP in hospitals located in the US. This new trend is associated with decreasing hospitalization costs. [ABSTRACT FROM AUTHOR]

Background: Pancreatic neuroendocrine tumors (PNET) account for less than 2% of all pancreatic tumors, while cystic PNETs account for only 10–18% of all resected PNETs. The most common site for metastasis is the liver. Few detailed guidelines currently exist for management of stage 4 cystic PNETs. This is a unique case that was managed with complete surgical resection in one sitting. Case presentation: Our report is on a young male patient who was initially misdiagnosed as having a pancreatic pseudocyst and treated accordingly. He was finally diagnosed with PNET but was reluctant to undergo surgery until he developed bilobar hepatic metastasis. We performed a pylorus-preserving pancreaticoduodenectomy with a Roux-en-Y hepaticojejunostomy and wedge resection of both hepatic metastatic deposits. Conclusion: Cystic PNETs are rare and commonly misdiagnosed as pancreatic pseudocysts. Surgical resection is considered ideal, but sparse literature exists on the management due to a paucity of cases. We have reported this case as it was successfully managed with single-stage surgery for both the primary tumor as well as bilobar hepatic metastatic deposits, and no similar cases have been reported in literature. The follow-up scan revealed no residual disease. [ABSTRACT FROM AUTHOR]

A Pancreatic Pseudocyst (PP) is a fluid-filled collection often found near the pancreas. It is characterised by its contained structure and homogeneous fluid composition, with little to no necrotic tissue. Individuals with a history of chronic pancreatitis, and to a lesser extent acute pancreatitis, may exhibit non specific symptoms. To minimise related morbidity and mortality, any potential complications must be identified. The authors present a case of a rare giant PP in a 28-year-old man who presented with abdominal pain and distention, severe backache, fever, frequent vomiting, loss of appetite, weight loss, and firm, sticky stools. Initially measuring 25Ã--19.2Ã--11.2 cm on a Computed Tomography (CT) scan, this PP was unusually large for its type. Due to the patient's condition not being suitable, a direct cystojejunostomy was performed. Three drains were placed: an anastomotic drain near the anastomosis site, a Morrison's drain in the Morrison pouch, and a pelvic drain. Later, a complication arose in the form of a faecal fistula, which was managed conservatively with a suction drain. The patient's only primary complaint was non specific stomach pain, despite the size of the pseudocyst. Therefore, individuals with a history of chronic alcoholism and symptoms such as abdominal pain and distension should be evaluated for PP. A CT scan is recommended to investigate this condition, despite its rarity. [ABSTRACT FROM AUTHOR]

Background and Aims: Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach. Methods: This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative (n = 26) or traumatic (n = 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and N-butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption. Results: PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients. Conclusions: Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic ultrasound (EUS)-guided drainage and luminal-apposing metal stents (LAMS) are the options for managing symptomatic pancreatic pseudocysts. Aim: To evaluate the effectiveness and safety of LAMS for EUS-guided drainage of symptomatic pancreatic pseudocysts in two referral centers in Colombia. Materials and methods: A multicenter prospective cohort study between June 2019 and December 2021 included 13 patients diagnosed with symptomatic pancreatic pseudocysts who underwent EUS-guided drainage with LAMS. Technical success, clinical success, and successful stent removal were evaluated as outcomes. Safety outcomes included stent-related adverse events and general adverse events. Follow-up was carried out for eight weeks, collecting data on stent removal. Results: The average age was 53.4 years; 8/13 were men. The mean size of the pseudocyst was 9.56 ± 2.3 cm. Technical success was 100%, and clinical success was 92.3%. The stents were removed on average after 8 ± 2 weeks. The mean procedural time from puncture to stent deployment was 3.2 ± 2.4 minutes. In the imaging check-up, the collections had adequate drainage in all cases. There was a low frequency of complications; bleeding was documented in one case requiring surgery. Conclusions: LAMS is safe and effective in managing symptomatic pancreatic pseudocysts, reducing hospital stay and cost overruns. Clinical symptomatology prevails in the surgery decision. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Pancreatic pseudocysts are rare in the pediatric population, commonly a result of trauma. Timely diagnosis and adequate management with a multidisciplinary approach are the key to avoid morbidity and mortality. Larger cysts often require surgical intervention. We report a case of a 4‐year‐old female child who presented with a massive pancreatic pseudocyst. Pseudocysts >10 cm are at an increased risk of rupture, hence require surgical intervention. Percutaneous external drainage via pigtail catheter was followed by cysto‐gastrostomy due to continuous high output. The postoperative period was uneventful. [ABSTRACT FROM AUTHOR]

Background: Knowledge on pancreatic pseudocyst (PP) management has mostly involved large database analysis, which limits understanding of a complex and heterogeneous disease. We aimed to review the clinical course and outcomes of PP and acute peripancreatic fluid collections (APFC) that require intervention at 1 high-volume center. Methods: Retrospective review of patients with APFC and PP undergoing drainage (2011-2018) was performed. Patients were divided into groups based on initial intervention: surgical (SR), percutaneous (PC), or endoscopic (EN) drainage. Primary outcome was mortality by initial intervention type. Secondary outcomes included subsequent interventions required, length of stay (LOS), readmission rates, and discharge disposition. Results: Of 88 patients, 40 (46.1%) underwent SR, 40 (44.9%) PC, and 8 (9.0%) EN. No patients in EN group had APACHE II scores>20. Pancreatic necrosis was higher in SR (80.5%) and PC (62.5%) groups (P =.006). There were no differences in mortality, LOS, or readmission rates. Ten patients in the PC group underwent subsequent surgical intervention, of which 9 were due to bowel ischemia. The PC group was 3.4 times more likely to be discharged to rehabilitation over home when compared to the other 2 groups (P =.04). Conclusion: Patients undergoing surgical or percutaneous drainage of APFC and PP have a greater burden of illness and more local complications requiring intervention compared to endoscopic drainage. The heterogeneity in presentation of peripancreatic fluid collections in acute pancreatitis must be considered when evaluating the benefits of each intervention. [ABSTRACT FROM AUTHOR]

Background: pseudocysts of the pancreas appear as a complication in acute and chronic pancreatitis, as well as in pancreatic trauma. Sometimes they go unnoticed, due to their asymptomatic nature in some cases, in addition to the poorly defined clinical picture. The studies oriented to this subject allow a satisfactory management of the patients diagnosed with said entity. Objective: to determine the prognostic factors for complications in patients with pancreatic pseudocyst. Methods: a longitudinal descriptive study was carried out in patients with pancreatic pseudocysts treated at the Arnaldo Milián Castro Hospital, in Villa Clara, from January/2013 to December/2020, 45 patients were the sample. Results: patients aged 40-59 years old (57.8%), and males (62.2%) predominated. The fundamental cause was acute pancreatitis (51.1%), and the most frequent location was the pancreatic body (37.8%). The most observed symptom was abdominal pain (82.2%). Medical management was performed in most of the patients (75.6%) and cystogastrostomy in 13.3%. 68.9% evolved without complications. Only 3 patients died (6.7%). Age greater than 52 years old, formation time greater than six weeks, size less than 6 centimeters, and persistence had Odds Ratio values: 1.214- IC(0.211-6.985); 7,250- CI(0,786-66,842); 4.688-CI(0.489-44.904); and 2.875-CI(0.479-17.239), respectively. Conclusions: age greater than 52 years old, formation after six weeks, size less than six cm, and persistence greater than three weeks are risk factors for complications of pancreatic pseudocyst. [ABSTRACT FROM AUTHOR]

The pancreatic pseudocyst contains pancreatic enzymes encapsulated by a non‐epithelialized wall. They are rare in the pediatric population and are mostly a result of pancreatic trauma: extrinsic, or intrinsic. Management options include conservative or surgical, depending on the clinical signs and symptoms, and the size of the cyst. [ABSTRACT FROM AUTHOR]

Background: A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD. Methods: This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD. Results: We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68–97.6, P = 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91–136.1, P = 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33–29.3, P = 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs. Conclusion: Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings. Clinical registration number: UMIN 000030898. [ABSTRACT FROM AUTHOR]

Introduction: To report on a clinical case of a pancreatic pseudocyst that evolved to rupture and to understand the main therapeutic approaches adopted for pancreatic pseudocysts, thus fostering a better approach to such cases. Case report: Female patient, 30 years old, with pseudocystoadenoma and acute abdomen due to cystic rupture. Discussion: The therapeutic forms for pancreatic pseudocysts are expectant management, drainage (endoscopic and percutaneous) and surgical treatment. Results: The best approach addresses the treatment of the patient's clinical condition and pancreatic pseudocyst. For this to happen, a clinical evaluation, by means of complementary examinations, is required. [ABSTRACT FROM AUTHOR]

Aim: To present a specific complication of chronic pancreatitis which is perforation of the small intestine due to the compressive effect of pseudocysts, and different ways of diagnosis and treatment of the same. Case report: A 60-year-old man was admitted to the emergency room due to diffuse abdominal pain and profuse vomiting of dark brown contents. Physical examination revealed palpatory abdominal wall pain and abdominal defanse. During hospitalization, a CT of the abdomen was made, which indicated an exacerbation of chronic pancreatitis.As a support of the exacerbation of chronic pancreatitis, s a large cystic formation (195x109x158mm) well limited was found, filled with denser content in gravity-dependent parts. A drain was placed in the pseudocyst for continuous emptying. After percutaneous drainage, a pseudocyst measuring 21x18mm persisted and made communication with a smaller cystic formation from the bursa omentalis. The next day, two pancreatic prosthesis were placed by ERCP technique due to stenosed ductus pancreaticus at the junction between the head and tail of the pancreas. Prior to the patient’s discharge, US of the abdomen showed a residual pseudocyst measuring 30x30mm. One week after discharge, the pacient came back to emergency room because of the vomiting, decressed appetite and energy, and weight loss. Further examinations revealed a perforation of the small intestine as the resault of adhesive ileus and peritonitis. The patient’s condition worsened in two days and he was described as anergic with decreased state of consciousness and he died that day in the intensive care unit. Conclusion: A pseudocyst that grows despite therapeutic procedures, and the symptoms and signs of ileus in the exacerbation of chronic pancreatitis should raise suspicion of compression disorders of cystic formation in the abdomen. [ABSTRACT FROM AUTHOR]

Background: A pancreatic pseudocyst is a collection of fluid surrounded by a well-defined wall that contains no solid material. Studies on outcomes of pancreatic pseudocyst drainage have largely been limited to small cohorts. This study aims to take a population based approach to evaluate differences in inpatient outcomes among laparoscopic, percutaneous, and endoscopic drainage for pancreatic pseudocysts. Methods: The National Inpatient Sample database was used to identify inpatient stays for pancreatic pseudocysts in which a single drainage approach was conducted. Baseline characteristic differences were compared with Rao-Scott chi squared and Mann–Whitney U tests. Propensity score matching controlling for clinical and demographic covariates followed by multivariable regression was used to pairwise compare drainage outcomes. Primary outcomes were length of stay, total charge, mortality, and disposition. Secondary outcomes were procedure related complication rates. Results: Among a total of 35,640 weighted pancreatic pseudocyst cases, 3235 underwent drainage via a single procedure. Percutaneous was the most frequent drainage method performed (44.5%) and was more likely to be performed at nonteaching hospitals than laparoscopic (17% vs 9%, p = 0.04). Percutaneous drainage was associated with longer LOS (aIRR 1.42, 95% CI 1.07–1.86, p = 0.01) versus endoscopic and lower rates of routine disposition (aOR 0.45, 95% CI 0.23–0.89, p = 0.02) relative to endoscopic and laparoscopic (aOR 0.41, 95% CI 0.27–0.61, p < 0.01) drainage. There were no differences in primary outcomes in laparoscopic versus endoscopic drainage. Percutaneous drainage was associated with higher rates of septic shock than laparoscopic drainage (aOR 2.59, 95% CI 1.15–5.82, p = 0.02). Conclusions: Endoscopic and laparoscopic pancreatic pseudocyst drainage are associated with the least short term procedure related complications and more favorable in-hospital outcomes compared to percutaneous approaches. However, percutaneous drainage was the most commonly performed method in the 2017 NIS database. [ABSTRACT FROM AUTHOR]

Background: Surgical pancreatic necrosectomy (SPN) is an option for the management of infected pancreatic necrosis. The literature indicates that an escalating, combined endoscopic, interventional radiology and minimally invasive surgery "step-up" approach, such as video-assisted retroperitoneal debridement, may reduce the number of required SPNs and ICU complications, such as multiple organ failure. We hypothesized that complications for surgically treated severe necrotizing pancreatitis patients decreased during the period of adoption of the "step-up" approach. Methods: The American college of surgeons national surgery quality improvement program database (ACS-NSQIP) was used to find SPN cases from 2007 to 2019 in ACS-NSQIP submitting hospitals. Mortality and Clavien-Dindo class 4 (CD4) ICU complications were collected. Predictors of outcomes were identified by univariate and multivariate analyses. Results: There were 2457 SPN cases. SPN cases decreased from 0.09% in 2007 to 0.01% in 2019 of NSQIP operative cases (p < 0.001). Overall mortality was 8.5% and did not decrease with time. CD4 complications decreased from 40 to 27% (p < 0.001). There was a 65% reduction in SPN cases requiring a return to the operating room. Multivariate predictors of complications were emergency general surgery (EGS, p < 0.001), serum albumin (p < 0.0001) and modified frailty index (mFI) (p < 0.0001). Multivariate predictors of mortality were EGS (p < 0.0001), serum albumin (p < 0.0001), and mFI (p < 0.04). The mFI decreased after 2010 (p < 0.001). Conclusion: SPNs decreased after 2010, with decreasing CD4 complications, decreasing reoperation rates and stable mortality rates, likely indicating broad adoption of a "step-up" approach. Larger, prospective studies to compare indications and outcomes for "step up" versus open SPN are warranted. [ABSTRACT FROM AUTHOR]

Background: There have been many reports on biomarkers for predicting the severity of acute pancreatitis (AP), but few studies on biomarkers for predicting complications; some simple and inexpensive indicators, in particular, are worth exploring. Methods: We retrospectively collected clinical data of 809 AP patients, including medical history and results of routine blood tests, and grouped them according to the occurrence of complications. Differences in clinical characteristics between groups with and without complications were compared using t‐test or χ2 test. Receiver operating curve (ROC) and area under the curve were calculated to evaluate the ability of predicting the occurrence of complications for the routine blood parameters with statistical differences. Then, through univariate and multivariate analyses, independent risk factors closely associated with complications were identified. Finally, we built a three‐parameter prediction system and evaluated its ability to predict AP complications. Results: Compared with the group without complications, the patients in the complication group had higher white blood cells, neutrophils, C‐reactive protein, and erythrocyte sedimentation rate (ESR), and lower red blood cells and hemoglobin (Hb) (all p <.05), and most of them had severe pancreatitis. In addition, pseudocysts were more common in patients with alcoholic etiology, recurrence, low BMI, and high platelet (PLT) and plateletocrit. Acute respiratory failure was more common in patients with first onset and high mean PLT volume (MPV). Sepsis was more common in patients with lipogenic etiology, high MPV, and low lymphocytes. Infectious pancreatic necrosis was more common in patients with alcoholic etiology. Acute renal failure was more common in patients with monocytes and high MPV and low PLT. Multivariate analysis showed that PLT and ESR were risk factors for pseudocyst development. The ROC showed that the combination of Hb, PLT and ESR had a significantly higher predictive ability for pseudocyst than the single parameter. Conclusion: Routine blood parameters can be used to predict the complications of AP. A predictive model combining ESR, PLT, and Hb may be an effective tool for identifying pseudocysts in AP patients. [ABSTRACT FROM AUTHOR]

Background: Both endoscopic and laparoscopic interventions have a high therapeutic success rate in the management of symptomatic pancreatic pseudocysts; however, neither has been established as the gold standard. Methods: A decision tree analysis was performed to examine the costs and outcomes of intervening on pancreatic pseudocysts endoscopically versus laparoscopically. Within the model, a theoretical patient cohort was separated into two treatment arms: endoscopic drainage and laparoscopic drainage. Variables within the model were selected from the published literature. Medicare reimbursements rates (US$) were used to represent costs accumulated during a 3-month perioperative period. Effectiveness was characterized by quality-adjusted life-years (QALYs). A willingness-to-pay of $100,000 per 1 year of perfect health (1 QALY) gained was used as the cost-effectiveness threshold. The model was validated using one-way, two-way, and probabilistic sensitivity analysis. Results: Endoscopic management of symptomatic pancreatic pseudocysts was the dominant strategy, producing 0.22 QALYs more while saving $23,976.37 in comparison to laparoscopic management. This result was further validated by one-way, two-way, and probabilistic sensitivity analysis. Conclusions: For patients presenting with symptomatic pancreatic pseudocysts amenable to either endoscopic or laparoscopic management, endoscopic drainage should be considered first-line therapy. [ABSTRACT FROM AUTHOR]

Introduction: pancreatic pseudocyst is a rare complication of pancreatitis; when hemorrhage occurs, the prognosis becomes poorer. Clinical case: a seven-year-old female patient with recurrent pancreatitis is presented, who developed a pancreatic pseudocyst. Surgical drainage was decided, but during the procedure it was detected that the pseudocyst was hemorrhagic. The patient died from hemorrhage and shock. Conclusions: hemorrhagic pancreatic pseudocyst represents a therapeutic challenge; currently, interdisciplinary management is recommended, which includes surgery and arterial embolization. [ABSTRACT FROM AUTHOR]

Background: Disconnected pancreatic duct syndrome (DPDS) frequently occurs in patients with acute necrotizing pancreatitis and resultant pancreatic fluid collection (PFC). We performed a systematic review and meta‐analysis to evaluate outcomes of endoscopic ultrasound‐guided treatment of PFCs according to the presence of DPDS. Methods: Using PubMed, Embase, and the Cochrane database, we identified clinical studies published until January 2021 with data comparing outcomes of endoscopic ultrasound‐guided drainage of PFCs between DPDS and non‐DPDS patients. We pooled data on technical and clinical success rates, PFC recurrence, and adverse events using the random‐effects model. Results: We identified five eligible articles including 941 PFC patients treated with endoscopic ultrasound‐guided interventions. Clinical success, defined as resolution of the PFC and symptoms, was achieved in a majority of the cases irrespective of DPDS (pooled odds ratio [OR] comparing DPDS to non‐DPDS patients, 0.77; 95% confidence interval [CI] 0.33–1.81). Compared to patients without DPDS, patients with DPDS were more likely to undergo PFC recurrence (pooled OR 6.72; 95% CI 2.72–16.6) after clinical resolution of PFC. Prolonged plastic stent placement following the clinical resolution was more frequently performed in DPDS patients than in non‐DPDS patients (pooled OR 15.9; 95% CI 2.76–91.9). No statistically significant difference was observed between the groups in terms of the rate of technical success, adverse events, or mortality. Conclusion: Disconnected pancreatic duct syndrome was associated with higher rate of PFC recurrence after successful endoscopic treatment of PFCs. Future studies should evaluate effectiveness and optimal duration of long‐term placement of transmural plastic stents for PFCs with DPDS. [ABSTRACT FROM AUTHOR]

We present a case report of a 2‐year‐old boy who presented to a local hospital to evaluate vague abdominal symptoms of one‐month duration. The patient, therefore, had an open cystogastrostomy and drainage of the free abdominal fluid with minimal complications. He was monitored for several days after his surgery. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic drainage is an established treatment modality for adult patients with pancreatic fluid collections (PFCs). Available data regarding the efficacy and safety of endoscopic drainage in pediatric patients are limited. In this systematic review and metaanalysis, we aimed to analyze the outcomes of endoscopic drainage in children with PFCs. Methods: A literature search was performed in Embase, PubMed, and Google Scholar for studies on the outcomes of endoscopic drainage with or without endoscopic ultrasonography (EUS) guidance in pediatric patients with PFCs from inception to May 2021. The study's primary objective was clinical success, defined as resolution of PFCs. The secondary outcomes included technical success, adverse events, and recurrence rates. Results: Fourteen studies (187 children, 70.3% male) were included in this review. The subtypes of fluid collection included pseudocysts (60.3%) and walled-off necrosis (39.7%). The pooled technical success rates in studies where drainage of PFCs were performed with and without EUS guidance were 95.3% (95% confidence interval [CI], 89.6-98%; I²=0) and 93.9% (95% CI, 82.6-98%; I²=0), respectively. The pooled clinical success after one and two endoscopic interventions were 88.7% (95% CI, 82.7-92.9%; I²=0) and 92.3% (95% CI, 87.4-95.4%; I²=0), respectively. The pooled rate of major adverse events was 6.3% (95% CI, 3.3-11.4%; I²=0). The pooled rate of recurrent PFCs after endoscopic drainage was 10.4% (95% CI, 6.1-17.1%; I2=0). Conclusion: Endoscopic drainage is safe and effective in children with PFCs. However, future studies are required to compare endoscopic and EUS-guided drainage of PFCs in children. [ABSTRACT FROM AUTHOR]

Introduction: The pancreatic pseudocyst is one of the late local complications of acute pancreatitis. For managing a giant pancreatic pseudocyst, there are multiple strategies. Aim: To present the case of a patient with a giant pancreatic pseudocyst managed by endoscopic cystogastrostomy. Clinical case: A 41-year-old woman developed a giant pancreatic pseudocyst as a complication of acute pancreatitis that was managed by endoscopic cystogastrostomy without endoscopic ultrasound guidance, with good evolution. Conclusions: Endoscopic cystogastrostomy, with or without the help of ultrasound endoscopy or lumen-apposing metal stent (LAMS), is a viable, safe, effective, and economical therapeutic option for selected patients with a giant pancreatic pseudocyst. [ABSTRACT FROM AUTHOR]

Background Cystogastrostomy is the most effective drainage method for large, persistent pancreatic pseudocyst (PP). There are many approaches for cystogastrostomy either open cystogastrostomy, laparoscopic cystogastrostomy (LCG), or nonsurgical techniques (endoscopic or percutaneous radiologic drainage). Patients and methods This was a prospective clinical trial single-center experience study on patients with PP who presented at our outpatient clinic at Ain Shams University hospitals during the period from January 2019 till January 2021. It included patients with symptomatic cyst of more than 6 cm with well-formed wall after 6 weeks from the last attack. The included cases underwent LCG, aiming to assess our early experience of LCG and its short-term outcome. Results A total of 20 patients with PP presented to us during the study period, and 16 (80%) patients met the inclusion criteria, and these patients underwent LCG. The mean operative time was 170.31 min, and the mean blood loss was 156.88 ml. Overall, 6.3% of our cases had open conversion. Concomitant cholecystectomy was done in 56.3% of our cases. The mean hospital stay was 6.31 days, with 12.5% of our cases had postoperative wound infection and 6.3% had postoperative hematemesis. No cases of recurrence or mortality were encountered in our study. Conclusion Laparoscopic drainage of PP has major advantages over the open approach in the form of less postoperative pain, hospital stay, and wound complications with comparable recurrence incidence. Our early experience in laparoscopic anterior cystogastrostomy approach was promising with good results and acceptable morbidity, which encouraged us to expand this approach in drainage of PP. [ABSTRACT FROM AUTHOR]

Hydatid disease (HD) is a zoonotic disease, which typically affects the liver and the lungs. Primary retroperitoneal localization of the disease is infrequent. The most common symptom is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. A 53-year-old female patient presented to Kocaeli University General Surgery Clinic, Turkey in September 2019 with complaints of flank pain, constipation and vomiting. The MRI revealed cystic lesions in the pancreas and psoas muscle. Both cysts were excised totally during laparotomy. Histopathology reports showed that the lesion in psoas muscle was hydatid cyst whereas the lesion in pancreas was pancreatic pseudocyst. Postoperative period was uneventful and the patient was discharged with albendazole treatment. No recurrence occurred during follow-up period. Atypical localization for hydatid disease is a diagnostic dilemma for surgeons, especially in endemic countries. Hydatid disease should always be considered in the differential diagnosis of retroperitoneal lesions, inadequate management can lead to complications and fatalities. Surgery combined with antiparasitic therapy, may be an option in the presence of obstruction of gastrointestinal and/or urinary tract. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a frequent condition with a significant morbidity and mortality (approximately 20% are complicated forms). Peripancreatic collections are a very common complication. The 2012 Atlanta classification distinguishes between 4 types of peripancreatic collections. Acute peripancreatic fluid collections and pseudocysts develop after acute interstitial oedematous pancreatitis and acute necrotic collections. Walled-off necrosis develops after acute necrotizing pancreatitis. Although these collections are mostly asymptomatic, it is sometimes necessary to drain them when symptoms appear. Management by endoscopic ultrasound (EUS) is the gold standard. In this review of the literature, we will focus only on the pseudocysts' drainage. With the rapid development of therapeutic EUS, new stents have been developed: lumen apposing metal stent (LAMS). Several studies focused on their use in peripancreatic collections drainage and particularly in pseudocysts. The technical and clinical successes are very high for this type of stent, above 90% for these two criteria. However, the cost of these stents is significant. LAMS redefine the management of peripancreatic collections. However, it is necessary to manage this type of condition in a collegial manner, due to sometimes-serious complications at the time of insertion or afterwards. Their superiority seems undeniable in the management of walled-off necrosis, but as far as pseudocysts with fluid content are concerned, the debate remains open. New studies should be carried out to clarify the position of these stents and their complications, especially in the management of pseudocysts. [ABSTRACT FROM AUTHOR]

Background: Management of symptomatic pancreatic pseudocysts poses a unique challenge to minimally invasive surgeons. Despite the predominance of endoscopic management of pancreatic pseudocysts, the laparoscopic approach remains a critical skill in the armamentarium of surgeons. Methods: This report details a laparoscopic intragastric approach to create a pancreatic cystgastrostomy using intraoperative ultrasound and endoscopy. Conclusion: Laparoendoscopic techniques for pancreatic pseudocysts are still required in selective cases when endoscopic management is not available or fails. Using this technique provides patients with same clinical benefits of an endoscopic approach. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Pancreaticopleural fistula (PPF) is a rare complication of acute and chronic pancreatitis. PPF results from the release of pancreatic enzymes, either from a damaged pancreatic duct or pancreatic pseudocyst. This report is of a 58-year-old woman with a history of chronic pancreatitis associated with gallstones who had a known pancreatic pseudocyst that was being managed conservatively and who presented to the Emergency Department with pleural effusion due to a PPF. Case Report: A 58-year-old woman with past medical history of gallstone pancreatitis with subsequent development of pancreatic pseudocyst (being managed conservatively) presented with a 2-week history of progressive exertional shortness of breath. Physical examination indicated decreased breath sounds on the right lower lung fields. A chest X-ray revealed possible subphrenic free air. Laboratory test results were unremarkable except for elevated D-dimer levels. Computed tomography angiography revealed a large right-sided pleural effusion, which led to thoracentesis and the results illustrated elevated amylase levels. Magnetic resonance cholangiopancreatography was done, which showed pancreatic pseudocyst and possibly a fistula. Pancreatic enzymes were not checked in pleural fluid, as diagnosis was established with the presence of amylase and imaging findings. The patient felt better clinically after thoracentesis with volume removal and was discharged. She later underwent endoscopic ultrasound, which revealed a pancreatic duct leak requiring stent placement. Conclusions: Pleural effusions rarely occur secondary to PPF. Physicians must be wary of the presentation, especially in patients with a history of a conservatively managed pancreatitis pseudocyst. Early diagnosis and management can lead to prevention of long-term morbidity and mortality. [ABSTRACT FROM AUTHOR]

In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, interventional procedure or surgical treatment are required at an appropriate time. Conservative treatment is considered for acute peripancreatic fluid collection. Endoscopic drainage could be considered preferentially for the treatment of pancreatic pseudocysts with clinical symptoms or complications. In the case of necrotizing pancreatitis, conservative treatment is preferred, but therapeutic intervention should be considered if infectious pancreatic necrosis with clinical deterioration is suspected. For therapeutic intervention, it is recommended to proceed with a step-up approach in which drainage is first performed and, if necessary, necrosectomy is performed. The optimal timing of intervention is considered 4 weeks after the onset of pancreatitis when necrosis become walled-off, but early drainage within 4 weeks can be considered depending on the patient's condition. This guideline provides an overview of current treatment strategies for local complications of acute pancreatitis. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic pseudocysts (PPCs) and walled-off necrosis (WON) in children following acute pancreatitis are uncommon. The various modalities of therapy possible are conservative treatment, external drainage, endoscopic stenting, and internal surgical drainage procedures. There are no existing guidelines for the management of PPC in children. We evaluate the outcomes of laparoscopic cystogastrostomy (LCG) performed at our center. Materials and Methods: Eight children (median age: 10 years) underwent LCG for large PPC (median size: 12.5 cm). There were seven patients with PPC and one with WON. Seven underwent LCG by a transgastric approach and one underwent LCG by a retrogastric approach. Results: Seven out of the eight patients had complete resolution of symptoms and the PPC. The median follow-up period was 32 months (interquartile range: 9.5–55.5 months). There were no conversions. There was one patient with a WON who developed a recurrence. Conclusion: LCG is a safe and effective treatment option for large PPC/WON in children. A posterior retrogastric approach, when indicated, is a safe approach with a comparable outcome. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic pseudocysts (PPCs) have been a topic of debate among surgeons, gastroenterologists, and radiologists regarding their etiology, evolution, and treatment. Often associated with acute or chronic pancreatitis, these accumulations of fluid located in the tissues surrounding the pancreas are sometimes partially or completely encapsulated within the pancreatic tissue itself, thus presenting challenging management. Case Report: A 55-year-old female patient presented in October 2023 with epigastric pain and nausea. The patient, known to have type 2 diabetes mellitus and class 2 obesity, underwent a cholecystectomy one year prior and was monitored for a PPC, a complication of a severe acute biliary necrotizing pancreatitis episode. On CT examination, the cyst measured 19/13cm and the images showed significant atrophy of the pancreatic parenchyma and splenic vein thrombosis with collateral blood flow. Multiple ultrasound (US) and endoscopic ultrasound (EUS) examinations were conducted, indicating the enlargement of the PPC and raising the suspicion of a Wirsung duct rupture. Magnetic resonance cholangiopancreatography (MRCP) ruled out any communication with the PPC, but the Wirsung duct was still stented during an endoscopic retrograde cholangiopancreatography (ERCP) procedure in December 2023. In January 2024, EUS-guided transmural drainage was performed using two plastic cysto-gastric pigtail stents, improving the patient's condition. In March 2024, the patient returned for clinical assessment, reporting a weight loss of 10kg without any accompanying symptoms. The pancreatic duct plastic stent was removed. A follow-up CT revealed a significant decrease in the PPC's dimensions (4 cm). The patient was discharged with pigtail stents still in place. Discussions : This complex case exemplifies the challenges of treating PPCs due to their volatile and sometimes unpredictable nature. Therefore, many questions arise: When is the optimal time to use EUS and to remove the pigtail stents? Should one opt for a more conventional, surgical approach? Surgical drainage used to be the preferred method for draining PPCs. Thanks to advancements in endoscopic techniques, surgical drainage is now reserved for specific scenarios, such as recurrent PPCs, malignant cyst resection, or symptomatic PPCs that are challenging to access endoscopically. Conclusions: PPCs are intricate and difficult conditions, yet this case exemplifies the importance of thorough surveillance of PPCs due to their unforeseeable implications. An integrated multi-disciplinary team approach, involving multiple specialists, is crucial to identify the best treatment for each individual patient. [ABSTRACT FROM AUTHOR]

A total of six patients with pancreatic ductal disruption (PDD), treated with image-guided endoscopy percutaneous drainage were enrolled. Initially, patients had infected pancreatic necrosis, treated with transgastric percutaneous drainage, and after the infection was controlled, they developed PDD. In the imaging study process, four patients were diagnosed with partial duct disruption and two patients with complete duct disruption. In both cases the placement of a percutaneous transgastric prosthesis to drain the pancreatic fluids to the stomach was indicated. The prosthesis remained 183 days on average and there were no mortality cases. This therapeutic minimally invasive alternative has low rates of morbimortality and thus, the endoscopy percutaneous transgastric approach is considered as a viable treatment in PPD. [ABSTRACT FROM AUTHOR]

Spontaneous rupture of a hemorrhagic pancreatic pseudocyst may be life-threatening. Endoscopic ultrasound (EUS)-guided drainage has been reported to be a valuable treatment option for pancreatic pseudocysts. However, its usefulness in the management of a ruptured pancreatic pseudocyst is limited. We report a rare case of a spontaneous rupture of a hemorrhagic pancreatic pseudocyst in a patient with chronic pancreatitis, which was successfully treated with EUS-guided gastrocystostomy with a fully covered self-expandable metallic stent. [ABSTRACT FROM AUTHOR]

Background: Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage.Case Presentation: A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient's symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess.Conclusions: While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy. [ABSTRACT FROM AUTHOR]

Introduction. The pancreas is the fourth most frequently involved solid organ in pediatric abdominal trauma. We present the case of a giant pancreatic pseudocyst secondary to trauma and how it was radiologically and surgically managed. Clinical case. This is the case of a 13-year-old male patient admitted as a result of a grade IV pancreatic lesion, which turned into a 170x86x180 mm pancreatic pseudocyst. Intracystic bleeding required radiological embolization of the proximal gastroduodenal artery. Subsequent abdominal compartment syndrome, biliary leak, and chemical peritonitis required laparotomy and collection drainage. Pancreatitis and duct fistula had a slow but favorable progression. Discussion. The presence of duct damage is a failure predictor in the conservative treatment of pancreatic trauma. Surgical management could be indicated in recurrent, multiple, or giant (> 200 mm) pseudocysts. Intracystic bleeding is rare but potentially fatal. Selective angiogram could be a useful tool for improved prognosis. [ABSTRACT FROM AUTHOR]

Over the last one-decade, endoscopic ultrasound (EUS)-guided drainage has evolved as a preferred modality for treating pseudocyst over conventional surgical or radiological procedures among adults using plastic stents or lumen opposing stents; however, studies on EUS-guided pancreatic of pseudocyst among children are mainly in the form of case reports or small case series. Therefore, we aimed to describe four pediatric cases of the pseudo-pancreatic cyst treated successfully with EUS-guided cysto-gastrostomy using plastic stents. In all four cases, EUS-guided drainage was successful using plastic stent with no major complications, and none of them required any follow-up endoscopic or surgical intervention. EUS-guided cysto-gastrostomy offers an excellent and safe alternative to surgery for treating pancreatic pseudocysts in children. [ABSTRACT FROM AUTHOR]

Pancreaticopleural fistula is one of the rarest complication of acute pancreatitis, chronic pancreatitis and pancreatic pseudocyst. Diagnosis requires a high index of clinical suspicion in alcoholic patients presenting with pancreatitis and associated recurrent pleural effusion. Diagnosis is delayed as patients usually present with predominant pulmonary symptoms of dyspnea and chest pain. Hereby authors presented a case, where a 50-year-old chronic alcoholic male presented with chief complains of shortness of breath and chest pain. Based on the chest radiograph, Computed Tomography (CT) scan and pleural fluid analysis diagnosis of pancreaticopleural fistula was made. The patient was managed with intercoastal tube drainage and symptomatic treatment for other complains. Medical management, endoscopic and surgical interventions bring out a good prognosis in pancreaticopleural fistula. [ABSTRACT FROM AUTHOR]

A pancreatic pseudocyst (PP) is a localized collection of pancreatic juice in pancreatic tissue or peripancreatic space reach, in amylase and other enzymes, surrounded by a cyst wall composed of fibrous wall or granulation tissue, and a cyst wall lacking epithelium. A PP develops after acute pancreatitis, chronic pancreatitis, pancreatic trauma, or obstruction of the main pancreatic duct. PP commonly presents with symptoms of abdominal pain, early satiety, nausea and vomiting in the setting of an abdominal mass. Diagnosis is based on clinical and laboratory tests (persistent high levels of amylase) and on imaging by abdominal ultrasound or computer tomography (CT) scan of a persistent pancreatic fluid collection present for at least 4 weeks. Pseudocysts cannot be removed until 6 weeks after an episode of pancreatitis, to allow the walls to thicken to at least 6mm and the pseudocyst to grow to at least 6cm in size; however, pseudocyst formation is difficult to date. We present a patient who had a ruptured PP and therefore underwent emergency laparotomy. The cyst wall was immature and therefore a cystenterostomy was not possible. PP excision was chosen because the PP was already ruptured and had dense immature cyst-bowel adhesions, a thin wall and absence of abnormality of pancreatic main duct; in addition, expertise was available. Our patient recovered well without complications in the 90-day follow-up and was subsequently discharged. [ABSTRACT FROM AUTHOR]

A 42-year-old Caucasian female presented with lower limb panniculitis and bilateral ankle arthritis in the absence of abdominal or other localizing symptoms. Abdominal imaging revealed subacute pancreatitis with pseudocyst formation. The clinical manifestations were compatible with pancreatitis, panniculitis, and polyarthritis syndrome (PPP syndrome), a very rare complication of pancreatic disease. The patient improved with conservative treatment for the pancreatic disease and systemic corticosteroids for the cutaneous and articular manifestations. We identified 59 patients with the PPP syndrome from the literature, the majority of patients being male (74.6%) with a median age of 49 (IQR 41–63.5) years. Acute pancreatitis is the most frequent underlying disorder (54.2%), but gastrointestinal symptoms are absent in 45.8% of patients. Pancreatic panniculitis has a predilection for the lower limbs, which are affected in 98.3% of cases. However, the cutaneous lesions may also involve the upper limbs and trunk. Arthritis is typically symmetric and polyarticular in nature, affecting both large and small joints. Of all patients who received treatment, 78.6% had a poor response. Death occurred in 27.1% of cases after a median duration of 8 (IQR 3.5–14) weeks [ABSTRACT FROM AUTHOR]

Surgical internal drainage of pancreatic pseudocyst can be done into the stomach, duodenum or jejunum depending on the anatomic relation of pseudocyst with hollow viscera. For cystojejunostomy, a Roux‑en‑Y loop is preferred over loop cystojejunostomy as former is thought to avoid the reflux of jejunal contents into the cyst cavity. This study presents our experience with laparoscopic loop cystojejunostomy showing loop cystojejunostomy for the pseudocyst of the pancreas can be safely performed laparoscopically with simpler technique with no complications including reflux. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic pseudocysts (PQP) correspond to 80% of cystic lesions of the pancreas. A cystic tumor must be ruled out, which represents 10% to 15% of pancreatic cysts and 1% of malignant tumors, so the study and differential diagnosis is essential. The term giant pancreatic pseudocyst is traditionally used when the size is greater than 10 cm. There are few cases of giant PQP in the national literature. Objective: To report a clinical case with giant PQP, to analyze the differential diagnosis and therapeutic options. Materials and Method: Patient with progressive abdominal distension, weight loss and anorexia post episode of acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging confirm a giant intra-abdominal cystic lesion. The patient was treated with an open Roux-en-Y pancreatic cystojejunostomy. Analysis of the content aspirated during surgery suggests PQP. The most relevant literature is reviewed for discussion. Results: Excellent postoperative clinical results, the histopathological study of the cyst wall, confirmed the diagnosis of pancreatic pseudocyst. At one year of follow-up, the patient remains asymptomatic. Discussion: The preoperative study is crucial to determine the differential diagnosis and rule out neoplastic or cystic parasitic lesions. Reported giant PSQs are rare and their surgical management will depend fundamentally on their size, anatomical relationships, and the experience of the treating team. [ABSTRACT FROM AUTHOR]

Pancreatobiliary disorder is a challenging clinical condition, especially when this condition is causing severe infection or biliary sepsis, and sometimes it requires intensive care unit (ICU) treatment. Biliary drainage is the mainstay of therapy; however, the choice of the drainage method is dependent on the patient's clinical condition and the disease itself. A 79-year-old female was transferred on a ventilator to our ICU from another hospital due to biliary sepsis, a large common bile duct stone, and an infected pancreatic pseudocyst. The patient also has other comorbidities such as heart problems, hypothyroidism, and diabetes mellitus. Bedside percutaneous transhepatic biliary drainage without fluoroscopy and percutaneous cyst aspiration was successfully performed, which improved the patient's condition; this was followed by an endoscopic approach, i.e., endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided pancreatic pseudocyst drainage. The clinical improvement showed itself in the change of the patient's respiratory status and ventilator mode. In conclusion, the percutaneous approach has a big role in managing critically ill patients in the ICU setting. However, expertise, training experience, and a multidisciplinary team approach are very important for successful management and patient outcome. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocysts are cystic cavities which are localized collection of pancreatic secretions, rich in amylase and other enzymes, present in and around pancreas, encased in a false epithelial lining of fibrous or reactive granulation tissue. Extension of a pancreatic pseudocyst into the mediastinum is rare. We are reporting a case of a 5-year-old child with mediastinal pancreatic pseudocyst which was successfully drained by cystojejunostomy. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocyst (PP) is a known complication of pancreatitis. When a rupture occurs, patients often become haemodynamically unstable and require emergency surgery for source control. Conventionally, such a procedure is carried out through open technique due to patient, surgeon and technical factors. We present two cases of emergency laparoscopic surgery performed for ruptured PP. Our first patient was a 53-year-old male with a ruptured 17.6 cm pancreatic body pseudocyst who underwent a laparoscopic washout, adhesiolysis, necrosectomy, distal pancreatectosplenectomy and cholecystectomy. The second patient was a 66-year-old male with a ruptured 11 cm pancreatic body pseudocyst who underwent laparoscopic surgery, subsequently converted to hand-assisted surgery. We compare our cases with the existing literature and discuss pertinent management considerations. In conclusion, we demonstrated that emergency laparoscopic adhesiolysis, necrosectomy and distal pancreatosplenectomy are feasible and safe for the management of ruptured pseudocyst when performed by an experienced surgeon. However, further studies are needed to determine the advantages or limitations of the minimally invasive surgical approach for the management of these complicated cases. [ABSTRACT FROM AUTHOR]

Introduction: According to the literature exocrine pancreatic insufficiency is relatively common among patients with diabetes mellitus (DM). Pseudocysts are the most common cystic lesions and may be formed in the setting of acute or chronic pancreatitis. However, whether DM is involved or not in pancreatic cyst formation is still not well established. Aim: To investigate the frequency and risk factors of cystic lesions in diabetic patients. Material and methods: One hundred and sixty-one patients with DM, with no previous history of pancreatic diseases, were prospectively included in the study. Endosonography followed by fine needle aspiration biopsy was then performed. Results: Finally, 33 of 161 patients (20.5%) were recognized with cystic lesions of the pancreas. Among them 5 patients were classified as cystic neoplasms, and 28 as pseudocysts. In the group of patients with pseudocysts, cystic lesions were significantly more prevalent in individuals with DM lasting less than 3 years. Prevalence of cystic lesions was significantly higher in metformin users in comparison to other diabetic patients (p < 0.05). Cystic lesions were more frequent in patients above 50 years of age (p < 0.05). Conclusions: The prevalence of cystic lesions in the diabetic population is higher than in the general population. DM seems to play a major role in the process of cyst development, especially in patients without previous history of pancreatitis. Higher prevalence of cystic lesions in early diabetes seems to be the first stage of pancreatic injury. The exact role of diabetes duration and type of treatment should be established. [ABSTRACT FROM AUTHOR]