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Z Gastroenterol 2015; 53(02): 125-135
DOI: 10.1055/s-0034-1385713
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Review of current therapy of pancreatic pseudocysts

Übersicht der aktuellen Therapie von Pankreaspseudozysten
L. Guenther
1   University Hospital of Giessen and Marburg
,
P. D. Hardt
2   Third Medical Department, University Hospital, Giessen
,
P. Collet
3   Surgery, University Hospital, Giessen
› Author Affiliations
Further Information

Publication History

28 July 2014

10 November 2014

Publication Date:
10 February 2015 (online)

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Abstract

Background and Aims: Therapeutic interventions for complicated pancreatitis, especially in pseudocysts and walled-off necroses as a sequel of necrotizing pancreatitis, have a long history. Originally a stronghold of classical surgery and radiology, in the last two decades this was increasingly supplemented by endoscopy, often with adjuvant percutaneous drainage, mostly reducing open surgery to a salvage intervention in case of failure and complication. This study aims to evaluate and compare the current therapeutic options for pancreatic fluid collections, especially pseudocysts.

Methods: Systematic literature search via MedLine and Pubmed was performed with comprehensive tabulations of original publications of the endoscopic, surgical and percutaneous therapeutic interventions in pancreatic pseudocysts and WON in the last 27 years. Only studies including more than 10 cases were further analysed. The results with regard to complications, outcome, recurrence and mortality were analysed for each approach, the risk of bias was assessed and a conclusive statement was made.

Results: The initial literature search identified 46 studies. 12 studies had to be excluded because the number of individuals included was too low. 34 endoscopic, 8 surgical and 8 percutaneous studies were further analysed, leading to a number of 2485 patients in this review. The short-term clinical success was 85 % for the endoscopic approach, 83 % for surgery and 67 % for the percutaneous intervention. The complication rates were 16 %, 45 % and 34 % for endoscopic, surgical and percutaneous therapy, respectively. Typical complications were hemorrhage, infection, perforation and, especially in the percutaneous approach, pancreatocutaneous fistulisation.

Conclusion: According to the high success and low complication rates the endoscopic intervention appears as the most efficient method. But each method has its own indications, restrictions and therefore patient groups. Therefore it is reasonable to consider all the available methods in a productive interdisciplinary manner for the ultimate benefit of the patient in the future.

Zusammenfassung

Hintergrund und Ziele: Therapeutische Interventionen für komplizierte Pankreatitis, insbesondere bei Pseudozysten und walled-off Nekrosen, haben eine lange Geschichte. Ursprünglich eine Hochburg der klassischen Chirurgie und Radiologie wurde sie in den letzten 2 Jahrzehnten zunehmend durch endoskopische Techniken ergänzt. Diese heute häufig in Kombination mit perkutaner Drainage angewandten Methoden haben dazu geführt, dass offen chirurgische Maßnahmen i. d. R. nur noch im Falle des Scheiterns oder bei Auftreten von Komplikation eingesetzt werden müssen. Diese Übersichtsarbeit hat das Ziel, die aktuellen Therapiemöglichkeiten für pankreatische Flüssigkeitsansammlungen, insbesondere Pseudozysten, zu bewerten und zu vergleichen.

Methoden: Eine systematische Literaturrecherche (MEDLINE/PubMed) relevanter Veröffentlichungen der endoskopischen, chirurgischen und perkutanen Interventionen für Pankreaspseudozysten der letzten 27 Jahre wurde durchgeführt. Die Ergebnisse wurden bezüglich Komplikationen, Erfolg, Rezidivrate und Mortalität für jeden Ansatz analysiert, die Gefahr eines möglichen Bias bewertet und eine abschließende Schlussfolgerung getroffen.

Ergebnisse: Die ursprüngliche Suche identifizierte 46 Studien. 12 davon wurden von dem Review ausgeschlossen, weil ihre Patientenzahlen zu niedrig waren (< 10 Fälle). Ausgewertet wurden dann 34 endoskopische, 8 chirurgische und 8 perkutane Studien, mit einer Gesamtzahl von 2485 Patienten. Der direkte klinische Erfolg betrug 85 % für den endoskopischen Zugang, 83 % für den chirurgischen Ansatz und 67 % für die perkutane Intervention. Die Komplikationsraten beliefen sich auf 16 %, 45 % und 34 %. Typische Komplikationen waren Blutungen, Infektionen, Perforationen und (in dem perkutanen) Ansatz pankreatokutane Fisteln.

Fazit: Anhand der hohen Erfolgs- und niedrigen Komplikationsraten erscheint der endoskopische Ansatz den anderen Verfahren überlegen zu sein. Dennoch hat jede Methode ihre eigenen Indikationen, Beschränkungen und daher auch Patientengruppen. Es erscheint sinnvoll, alle verfügbaren Methoden in einer produktiven interdisziplinären Weise zum Vorteil des Patienten zu verbinden.

Schlusselwörter

Pankreaspseudozysten - walled-off Nekrosen - endoskopische Drainage - chirurgische Drainage - Pankreatitis - perkutane Drainage

Key words

pancreatic pseudocysts - walled-off necrosis (WON) - endoscopic drainage - surgical drainage - pancreatitis - percutaneous drainage
 

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