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Ann R Coll Surg Engl 2003; 85
Conservative treatment as an option in the management
of pancreatic pseudocyst
CVN Cheruvu, MG Clarke, M Prentice, IA Eyre-Brook
Department of Surgery, Taunton & Somerset Hospital, Taunton, Somerset, UK
Background: Management of pancreatic pseudocysts is associated with considerable morbidity
(15–25%). Traditionally, pancreatic pseudocysts have been drained because of the perceived risks of
complications including infection, rupture or haemorrhage. We have adopted a more conservative
approach with drainage only for uncontrolled pain or gastric outlet obstruction. This study reports
our experience.
Patients and Methods: A consecutive series of 36 patients with pancreatic pseudocysts were treated
over an 11-year period in one district general hospital serving a population of 310,000. This study
group comprised of 19 men and 17 women with a median age of 55 years (range, 10–88 years).
Twenty-two patients had a preceding attack of acute pancreatitis whilst 12 patients had clinical and
radiological evidence of chronic pancreatitis. The aetiology comprised of gallstones (16), alcohol
(5), trauma (2), tumour (2), hyperlipidaemia (1) and idiopathic (10).
Results: All patients were initially managed conservatively and intervention, either by
radiological-assisted external drainage or cyst-enteric drainage (by surgery or endoscopy), was only
performed for persisting symptoms or complications. Patients treated conservatively had 6
monthly follow-up abdominal ultrasound scans (USS) for 1 year. Fourteen of the 36 patients (39%)
were successfully managed conservatively, whilst 22 patients required intervention either by
percutaneous radiological drainage (12), by endoscopic cystogastrostomy (1) or by open surgical
cyst-enteric anastomosis (9). Median size of the pancreatic pseudocysts in the 14 patients managed
conservatively (7 cm) was nearly similar to that of the 22 patients requiring intervention (8 cm). The
most common indications for invasive intervention in the 22 patients were persiste