Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6254-6267
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6254
Sequential therapy with combined trans-papillary endoscopic naso-pancreatic and endoscopic retrograde pancreatic drainage for pancreatic pseudocysts
Yong-Gang He, Jing Li, Xue-Hui Peng, Jing Wu, Ming-Xun Xie, Yi-Chen Tang, Lu Zheng, Xiao-Bing Huang
Yong-Gang He, Jing Li, Xue-Hui Peng, Jing Wu, Yi-Chen Tang, Lu Zheng, Xiao-Bing Huang, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Ming-Xun Xie, Department of Radiology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Author contributions: He YG, Huang XB and Li J contributed to conception and design of the study, and drafted the manuscript; Peng XH, Wu J, and Tang YC contributed to analysis and interpretation of the data and revised the manuscript; Xie MX and Zheng L participated in clinical treatment and the literature research; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81672902; and the Hospital Research Fund (General Project) from The Second Affiliated Hospital of Army Medical University, No. 2016YLC18 and No. 2019XLC2006.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the Second Affiliated Hospital of Army Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest to disclose.
Data sharing statement: The authors declare that all the data have been provided in the article, and there are no additional data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Xiao-Bing Huang, MD, PhD, Professor, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China. 1038915320@qq.com
Received: April 2, 2021
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
Processing time: 116 Days and 11.5 Hours
Abstract
BACKGROUND

Endoscopic retrograde pancreatic drainage (ERPD) and stent implantation has become the major treatment method for pancreatic pseudocysts. However, it is associated with a high recurrence rate and infection.

AIM

To manage pancreatic pseudocysts by sequential therapy with endoscopic naso-pancreatic drainage (ENPD) combined with ERPD and evaluate the treatment outcome.

METHODS

One hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed. There were 152 cases of intubation via the duodenal papilla, of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD (two-step procedure). 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.

RESULTS

The incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). Twelve patients developed infection in the ERPD group, and anti-infection therapy was effective in five cases but not in the remaining seven cases. Infection presented as fever and chills in the two-step procedure group. The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group (P < 0.05). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases).

CONCLUSION

Sequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.

Keywords: Endoscopy; Endoscopic retrograde cholangiopancreatography; Endoscopic nasobiliary drainage; Endoscopic retrograde pancreatic drainage; Pancreatic pseudocyst; Endoscopic ultrasonography trans-gastric puncture drainage of the pancreas

Core Tip: In recent years, with the development of endoscopic technology, endoscopic pancreatic pseudocyst drainage has become the major treatment method for pancreatic pseudocyst. We reported 60 cases of pancreatic pseudocyst treated by sequential therapy with endoscopic naso-pancreatic drainage combined with endoscopic retrograde pancreatic drainage, and evaluated the treatment effect. The two-step method can significantly reduce the incidence and recurrence rate of postoperative infection.