Previously reported series suggested that the morbidity rate of internal surgical drainage procedure alone was about 15% and the mortality rate was less than 5% in patients with pancreatic pseudocysts. Recently, ultrasonography or CT-guided percutaneous drainage and endoscopic drainage techniques have created a new dimension of invasive, non-surgical treatment options for these patients. In the absence of prospective, randomized, controlled studies comparing outcomes of different pseudocysts drainage techniques, the decision as to which method should be employed often lies with local expertise and enthusiasm. In our experience, radiologic percutaneous drainage with subsequent transpapillary endosopic drainage had a high success rate and was relatively less difficult which resulted in rapid clinical improvement. We report three cases of pancreatic pseudocysts treated with percutaneous drainage as a first-line treatment followed by endoscopic treatment.
Aged ; *Cholangiopancreatography, Endoscopic Retrograde ; *Drainage/instrumentation ; Female ; Hemostasis, Surgical ; Humans ; Male ; Middle Aged ; Pancreatic Ducts/radiography ; Pancreatic Pseudocyst/*radiography/*therapy ; Tomography, X-Ray Computed

We report a case of a mediastinal pseudocyst with a pleural effusion that developed in a patient suffering from alcohol-related chronic pancreatitis. A 53-year-old man was admitted to another institution complaining of pleuritic chest pain and coughing. A chest X-ray revealed a pleural effusion with a collapse of the right middle and lower lobes. Pleural fluid taken by thoracentesis was exudative, and the patient was transferred to our institution. A CT scan showed a loculated cystic lesion in the mediastinum and pancreatic changes that were consistent with chronic pancreatitis. The endoscopic retrograde cholangiopancreatography (ERCP) findings were compatible with chronic pancreatitis showing severe pancreatic ductal stricture at the head with an upstream dilation and distal bile duct stricture. After a one week of treatment with fasting and octreotide without improvement, both pancreatic and biliary stents were placed endoscopically. After stenting, the pleural effusion and pseudocyst rapidly resolved. The stents were changed 3 months later, at which time a repeated CT demonstrated a complete resolution of the pseudocyst. Since the initial stenting, he has been followed up for 7 months and is doing well with no recurrence of the symptoms, but he will need to undergo regular stent changes. Overall, endoscopic pancreatic stenting appears to be a good option for managing selected cases of mediastinal pancreatic pseudocysts.
*Endoscopy ; Human ; Male ; Mediastinal Neoplasms/*complications/radiography/therapy ; Middle Aged ; *Pancreatic Ducts ; Pancreatic Pseudocyst/*complications/radiography/therapy ; Pleural Effusion/*complications/therapy ; Radiography, Thoracic ; *Stents ; Tomography, X-Ray Computed ; Treatment Outcome