Endoscopic Cystogastrostomy Versus Open Cystogastrostomy Drainage for Pancreatic Pseudocyst: A Comparative Study

Abstract

Priyanka RK, Sharanabasavaraj Javali*, Prashant Kanni Y, Shruti Sahu and Mohan LN

Introduction: Pancreatic pseudocyst is a localized peripancreatic fluid collection that results from pancreatic inflammation due to pancreatitis, trauma or ductal obstruction due to stricture or stone. Pancreatic pseudocyst drainage through the stomach or small intestine can be performed by open drainage, considered as standard treatment, and the endoscopic approach is less invasive than open surgery. This study aimed to compare the efficacy of open and endoscopic cystogastrostomy for the drainage of pancreatic pseudocysts.

Materials and methods: Thirty patients diagnosed (based on CECT (Contrast-Enhanced Computed Tomography)) with pancreatic pseudocysts (size being>6 cm) requiring intervention were considered. Patients were divided into 2 groups; Group 1 consisted of patients planned for open cystogastrostomy drainage and Group 2 consisted of patients planned for endoscopic ultrasound-guided Drainage. Patients were followed up for 6 months after discharge to record any complications.

Results: There was no statistically significant difference found between the two groups with respect to age, gender, presence of co-morbidities, presenting symptoms and signs, location of pseudocyst, presence or absence of complication during the procedure and hospital stay (p>0.05). The complications were observed in 26.7% and 46.15% of patients in groups 1 and 2 respectively. In follow-up, 6 patients in group 1 and one in group 2 exhibited complications. However, this was not statistically significant (p=0.08). No recurrence was seen in either group during the 6-month follow-up period. Duration of hospital stay was significantly lower in group 2 compared to group 1 (p<0.05).

Conclusion: Both endoscopic and surgical drainage procedures, are equal in terms of efficacy and success rates; the use of ultrasound guidance for the endoscopic procedures is probably attributable to the good success rate. However, endoscopic drainage should be considered the first line of management for pancreatic pseudocysts when available owing to the lower treatment cost, lesser duration of hospitalisation and lesser morbidity associated with the procedure in the long run.