Management of chronic pancreatitis complicated with a bleeding pseudoaneurysm

Table 1 Summary of studies concerning chronic pancreatitis-related bleeding

Ref.	Study design	n	Intervention	Comments
Gambiez et al[10]	Retrospective	14	Angioembolization or surgery	The immediate effectiveness of arterial embolization was remarkable. Subsequent surgery should be reserved for patients in a good general condition with other chronic pancreatitis (CP)-related complications that are not amenable to minimally invasive techniques
El Hamel et al[11]	Retrospective	15	Surgery	Favorable results were achieved in two-thirds of patients undergoing primary pancreatic resection which is recommended whenever possible for the treatment of bleeding pancreatic pseudocysts and pseudoaneurysms associated with CP
Udd et al[17]	Retrospective	33	Angioembolization or surgery	All hemodynamically stable patients with CP and bleeding pseudoaneurysms should undergo prompt initial angiographic evaluation and embolization if possible. Emergency hemostatic surgery is indicated for unsuccessful embolization
Bergert et al[22]	Retrospective	27	Angioembolization or surgery	Angioembolization is effective to stop CP-related bleeding. Partial pancreatectomy is superior to vessel ligation
Hsu et al[24]	Retrospective	9	Angioembolization and/or surgery	Angiography is valuable in localizing bleeding pseudoaneurysms. Patients with bleeding pseudoaneurysms associated with CP treated surgically seemingly obtained good outcomes
de Perrot et al[26]	Retrospective	6	Angioembolization and/or surgery	Angiography followed by transcatheter embolization is effective to stop bleeding. Pancreatic resection should be performed for the treatment of pseudoaneurysms
Savastano et al[27]	Retrospective	8	Angioembolization and/or surgery	Angioembolization is effective to stop acute bleeding in CP to achieve a stable condition quickly. Subsequent surgery is needed to obtain definite treatment
Bhasin et al[31]	Retrospective	8	Percutaneous thrombin injection/embolization and endoscopic retrograde transpapillary drainage of pseudocyst	Embolization followed by transpapillary drainage is effective to manage CP patients complicated with a bleeding pseudocyst