Drainage with a combination of nasocystic drain and transmural stent outperformed stents alone in treating debris-laden pancreatic pseudocysts, researchers found.
Patients whose pancreatic pseudocysts were drained via stent and nasocystic tubes had a significant threefold higher short-term success rate versus stents alone (P=0.03), and had significantly lower rates of stent occlusion (13% versus 33%, P=0.03), according to Ali Siddiqui, MD, of Thomas Jefferson University Hospital in Philadelphia, and colleagues.
Complete resolution of the debris-laden pseudocysts was more common among those treated with the tube and stent versus stent alone (79% versus 58%), though this difference was not significant (P=0.059), they wrote online in the journal Gastrointestinal Endoscopy.
Among patients with pancreatitis, pseudocysts occur in 10% to 20% of those with acute disease and in 20% to 40% of those with chronic disease.
These cysts are usually treated with surgery, but the procedure is associated with a 35% adverse event rate and 10% risk of mortality, they wrote. Drainage of these cysts is indicated for intra-abdominal symptoms, cyst-related adverse events, or rapid increase in size, though drainage is not without its own problems.
The authors noted that endoscopic ultrasound-guided drainage is minimally invasive, "is as effective as surgery, causes fewer adverse events, and is more cost-effective compared with surgery."
They conducted a study to determine whether the addition of a nasocystic tube drain to stent draining would be "particularly useful to facilitate irrigation of the cyst cavity when the fluid to be drained has a significant amount of debris." Results measured included short- and long-term outcomes, procedure-related adverse events, reintervention, and occlusion in pancreatic cyst drains performed in 88 patients whose cysts contained viscous solid debris-laden fluid.
All pseudocysts were symptomatic, rapidly enlarging, and/or infected. The authors excluded patients who had pancreatic necrosis, neoplastic lesions, intervening varices, coagulopathy, or thrombocytopenia.