Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6254
Peer-review started: April 2, 2021
First decision: April 28, 2021
Revised: May 7, 2021
Accepted: June 3, 2021
Article in press: June 3, 2021
Published online: August 6, 2021
Endoscopic retrograde pancreatic drainage (ERPD) and stent implantation is associated with a high recurrence rate and infection rate.
A two-step trans-papillary procedure involving endoscopic naso-pancreatic drainage (ENPD) and ERPD sequential therapy for pancreatic pseudocysts may reduce the infection-related complications seen with single stent implantation, address concerns related to tube blockage, and reduce patient discomfort due to long-term single naso-pancreatic duct implantation.
To manage pancreatic pseudocysts by sequential therapy with ENPD combined with ERPD and evaluate the treatment outcome.
One hundred and fifty-two cases of pancreatic pseudocysts were intubated via the duodenal papilla, and 92 cases involved pancreatic duct stent implantation and 60 cases involved sequential therapy with ENPD combined with ERPD. The success rate of the procedure, incidence of complications (infection, bleeding, etc.), recurrence, and length and cost of hospitalization were compared between the two groups.
The incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). The reoperation rate was also significantly higher in the ERPD group (7 cases) than in the two-step procedure group (0 cases). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases).
Two-step sequential therapy with ENPD combined with ERPD is safe and effective in patients with pancreatic pseudocysts.
The sequential therapywith trans-papillary ENPD combined with ERPD for pancreatic pseudocysts meets the physiological requirements and avoids complications, such as infection and bleeding of the cyst. Compared with pancreatic duct stenting, it facilitates postoperative observation and makes rinsing and unblocking easier after duct blockage, which greatly reduces the risk of infection and shortens the treatment time of pancreatic pseudocysts with a low recurrence rate, effectively reducing the total treatment costs. The two-step procedure can be widely used in clinical practice with low requirements for devices; thus, this sequential therapy is particularly suitable for hospitals at all levels.