Effect of failed computed tomography-guided and endoscopic drainage on pancreatic pseudocyst management.

Background: Computed tomography and endoscopic drainage are used increasingly to treat pancreatic pseudocysts (PP). We reviewed our experience with PP to compare the outcomes of patients operated on initially (group 1) with those whose nonoperative treatment failed (computed tomography-guided or endoscopic drainage) before operation (group 2).

Methods: The records of 70 consecutive patients operated on for PP were reviewed. The 52 patients (74%) in group 1 and 18 (26%) in group 2 were compared in terms of clinical features, laboratory test results on examination and before operation, operative findings, morbidity, mortality, and recurrence rates.

Results: Before the initial drainage attempt, mean serum amylase level was higher in group 2 (542 +/- 25 vs 163 +/- 17 IU/L; p = 0.01). All other laboratory values were similar. Before operative drainage, group 2 patients had lower hemoglobin (10.7 +/- 0.5 vs 12.2 +/- 0.3 gm/dl; p < 0.05) and serum albumin level (2.7 +/- 0.2 vs 3.5 +/- 0.1 mg/dl; p < 0.01) than group 1. Morbidity was twice as frequent in group 2 (33% vs 14%). The time from initial attempt at drainage to PP resolution was longer in group 2 (104 +/- 36 vs 20 +/- 4 days; p = 0.01). However, the time from operation to resolution was similar in both groups (21 +/- 8 vs 20 +/- 4 days).

Conclusions: Failed nonoperative drainage is associated with a protracted illness and carries a risk of increased morbidity after operative intervention.