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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6850-6860
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6850
Minimally invasive treatment of pancreatic pseudocysts
Enver Zerem, Goran Hauser, Svjetlana Loga-Zec, Suad Kunosić, Predrag Jovanović, Dino Crnkić
Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina
Enver Zerem, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, 71000 Sarajevo, Bosnia and Herzegovina
Goran Hauser, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
Svjetlana Loga-Zec, Institute of Pharmacology, Medical Faculty, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
Suad Kunosić, Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
Dino Crnkić, Faculty of Pharmacology, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
Author contributions: Zerem E contributed to the conception and design of the paper, the writing of the paper and the final revision; Hauser G contributed to the literature search, the writing of the paper and the final revision of the paper; Loga-Zec S, Kunosić S, Jovanović P and Crnkić D contributed to the writing of the paper and the final revision of the paper.
Conflict-of-interest: All authors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Enver Zerem, MD, PhD, Department of Gastroenterology, University Clinical Center Tuzla, Trnovac bb, 75000 Tuzla, Bosnia and Herzegovina. zerem@live.com
Telephone: +387-35303300 Fax: +387-35266485
Received: January 24, 2015
Peer-review started: January 25, 2015
First decision: March 10, 2015
Revised: March 29, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: June 14, 2015
Abstract

A pancreatic pseudocyst (PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall. Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage (PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity.

Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.

Keywords: Complications, Pseudocyst, Treatment, Drainage, Outcomes

Core tip: Pancreatic pseudocysts (PPCs) are common complications of acute and chronic pancreatitis, pancreatic trauma, and pancreatic duct obstruction. They can be treated with a variety of methods: percutaneous catheter drainage, endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. It is a difficult decision whether to treat a patient with a PPC and if so, with what treatment modalities and when. This article presents and critically evaluates the minimally invasive approaches for the treatment of PPCs.