• children
• chronic pancreatitis (CP)
• endoscopic retrograde pancreatography (ERP)
• pancreas divisum
• pseudocyst

• complications
• management strategies
• outcomes
• pancreatic pseudocysts
• surgical techniques

• Humans
• Male
• Female
• Retrospective Studies
• Aged
• Drainage/economics
• Drainage/methods
• United States
• Medicare/economics
• Databases, Factual
• Aged, 80 and over
• Patient Readmission/statistics & numerical data
• Patient Readmission/economics
• Hospital Costs/statistics & numerical data
• Treatment Outcome
• Longitudinal Studies

• Intrahepatic pancreatic pseudocyst
• Octreotide
• Pancreatico-pleural fistula
• Trauma
• Wayward cyst

• Abdominal imaging
• Diagnostic radiology
• Interventional radiology
• Pancreatic pseudocyst
• Pseudocyst

• Enzyme-modified cheese
• Microbial lipases
• food industry
• immobilization techniques
• pharmaceuticals
• phospholipase

• Lipase/metabolism
• Enzymes, Immobilized/chemistry
• Enzymes, Immobilized/metabolism

Pancreatic pseudocyst is a usual complication of chronic pancreatitis. Diagnosis is usually established with the help of cross-sectional imaging. Typical presenting complaints are abdominal pain and vomiting. However, atypical presentations of pseudocyst of the pancreas continue to puzzle clinicians throughout the world, leading to difficulty in diagnosis and hence, the development of life-threatening complications. Here, we report a case of a 47-year-old male who was a known case of chronic pancreatitis related to alcoholism presenting with dyspnea, dysphagia, chest pain, and vomiting with a blood pressure of 70/50 mmHg, which upon evaluation revealed to be a case of peripancreatic pseudocysts extending into mediastinum abutting inferior vena cava and right atrium presenting as acute shock syndrome. The patient was managed with ultrasound-guided pigtail insertion and drainage of pseudocyst of pancreas. Eventually, the patient’s clinical condition did not allow for surgical exploration of the thorax and the patient succumbed.

A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. The ideal management for giant PPs is controversial. Endoscopic drainage is an alternative nonsurgical approach for PP management. Only a few cases of giant PPs were reported to be managed by endoscopic drainage. Case Presentation. We reported two cases of giant PPs following an episode of acute pancreatitis. Both were resolved following endoscopic cystogastrostomy using metallic and double-pigtail stents with excellent outcomes. There was no history of recurrence or complications on follow-up. In addition, we extensively reviewed all available literature studies of giant pancreatic pseudocyst presentation, management, and complications. We summarized all reported cases and presented them in a comprehensive table.

The endoscopic cystogastrostomy approach is cost saving, can avoid surgical complications, and offers an early hospital discharge.

• Complications of pancreatitis
• laparoscopic Roux-en-Y cystojejunostomy
• laparoscopic loop cystojejunostomy
• pancreatic pseudocyst

• drainage
• pancreatitis
• retroperitoneal

• Abdominal Abscess/diagnostic imaging
• Abdominal Abscess/etiology
• Abdominal Abscess/therapy
• Combined Modality Therapy
• Drainage
• Humans
• Male
• Middle Aged
• Pancreatitis, Acute Necrotizing/complications
• Retroperitoneal Space
• Thigh/diagnostic imaging

Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy.

Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled. Two groups were studied based on fluoroscopy use. Technical success was defined as uneventful insertion of ELAMS at time of procedure. Clinical success was defined as (i) clinical resolution of symptoms after the procedure and (ii) >75% reduction in cyst size on computed tomography 8 weeks after stent placement. Adverse events including bleeding, stent migration, and infection were recorded.

A total of 21 patients (13 males) had PFCs drainage with ELAMS in the study period. The mean age was 51.6 ± 14.2 years. Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst. The mean size of the PFCs was 11.3 ± 3.3 cm. Fluoroscopy was used in seven cases (33%) and was associated with a longer procedure time compared to non-fluoroscopy (43.1 ± 10.4 vs 33.3 ± 10.5 min, P = 0.025). This association was independent of the size, location, or type of PFCs. Fluoroscopy had no effect on the technical success rates. In fluoroless procedures, the clinical resolution was 91% as compared to 71% in fluoroscopy procedures (P = 0.52) and the radiologic resolution was 57% as compared to 71% in fluoroscopy procedures (P = 0. 65). Three cases of stent migration/displacement occurred in the fluoroless procedures.

ELAMS may avoid the need for fluoroscopy during cystogastrostomy. Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.

•

Giant pseudocysts of pancreas may not be as rare as they were thought to be.

A Pancreatic pseudocyst is usually a complication of pancreatitis but may follow abdominal trauma in children. Giant pseudocysts are rare and usually complicate chronic pancreatitis.

To report 3 cases of giant pseudocysts of the pancreas managed in our Centre within a three-month-period.

Two female patients aged 22 years and 65 years respectively, and an 11-year-old boy presented with giant pancreatic pseudocysts (>10 cm in diameter each) to our unit and were successfully managed.

They all underwent exploratory laparotomy and cysto-gastrostomy with good outcome.

Giant pseudocysts of pancreas may not be as rare as they were thought to be. They can be effectively managed by cysto-gastrostomy

• Cysto-gastrostomy
• Giant pseudocysts
• Pancreas

• Endoscopic ultrasonography
• Enteral feeding
• Pancreatic pseudocyst
• Pancreatitis
• Stents

• Acute pancreatitis
• endoscopy
• lumen-apposing metal stent
• pseudocyst
• therapy
• walled-off pancreatic necrosis

• Acute Disease
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Drainage/adverse effects
• Drainage/instrumentation
• Drainage/methods
• Endosonography
• Humans
• Pancreatic Pseudocyst/diagnostic imaging
• Pancreatic Pseudocyst/etiology
• Pancreatic Pseudocyst/therapy
• Pancreatitis/complications
• Pancreatitis/diagnosis
• Pancreatitis, Acute Necrotizing/diagnostic imaging
• Pancreatitis, Acute Necrotizing/etiology
• Pancreatitis, Acute Necrotizing/therapy
• Prosthesis Design
• Stents
• Syndrome
• Tomography, X-Ray Computed
• Treatment Outcome
• Ultrasonography, Interventional

• T32 DK108733 NIDDK NIH HHS

Pancreatic fluid collections (PFCs), common sequelae of acute or chronic pancreatitis, are broadly classified as pancreatic pseudocysts or walled-off necrosis according to the revised Atlanta classification. Endoscopic ultrasound (EUS)-guided drainage is often considered a standard first-line therapy preferable to surgical or interventional radiology approaches for patients with symptomatic PFC. EUS-guided drainage is effective and successful; it has a technical success rate of 90%-100% and a clinical success rate of 85%-98%. Recent studies have shown a 5%-30% adverse events (AEs) rate for the procedure. The most common AEs include infection, hemorrhage, perforation and stent migration. Hemorrhage, a severe and sometimes deadly outcome, requires a well-organized and appropriate treatment strategy. However, few studies have reported the integrated management of hemorrhage during EUS-guided drainage of PFC. Establishing a practical therapeutic strategy is an essential and significant step in standardized management. The aim of this review is to describe the current situation of EUS-guided drainage of PFCs, including the etiology and treatment of procedure-related bleeding as well as current problems and future perspectives. We propose a novel and meaningful algorithm for systematically managing hemorrhage events. To our limited knowledge, a multidisciplinary algorithm for managing EUS-guided drainage for PFC-related bleeding has not been previously reported.

• Pancreatic fluid collections
• Hemorrhage
• Endoscopic ultrasound-guided
• Treatment algorithm
• Adverse events

This article describes the latest diagnostic and therapeutic recommendations in chronic pancreatitis, developed by the Working Group of the Polish Society of Gastroenterology and the Polish Pancreas Club. The recommendations refer to the diagnosis of chronic pancreatitis, autoimmune pancreatitis, conservative management, treatment of pain, and exocrine and endocrine pancreatic insufficiency, treatment of chronic pancreatitis by endoscopic and surgical methods, and oncological surveillance of chronic pancreatitis. This paper refers to the Polish recommendations published in 2011, which have been updated and supplemented. All recommendations were voted by experts of the Polish Society of Gastroenterology and the Polish Pancreas Club, who evaluated them each time on a five-degree scale, where I meant full acceptance, II – acceptance with some reservation, III – acceptance with serious reservation, IV – rejection with some reservation and V – full rejection. The results of the voting, together with a brief commentary, have been included with each recommendation put to the vote. In addition, the expert group assessed the value of clinical studies on which the statements are based, on a scale where A means high (based on meta-analyses and randomised clinical trials), B means medium (based on clinical trials and observational studies), and C means low (based mainly on expert opinion).

• Polish Pancreas Club
• Polish Society of Gastroenterology
• chronic pancreatitis
• endoscopic treatment
• endosonography
• enzymatic replacement therapy
• guidelines
• pancreatic cancer
• surgical treatment

• chronic pancreatitis
• multiple pseudocysts
• pancreatic panniculitis

• Humans
• Male
• Middle Aged
• Pancreatic Diseases/etiology
• Pancreatic Diseases/pathology
• Pancreatic Pseudocyst/etiology
• Pancreatic Pseudocyst/pathology
• Pancreatitis, Chronic/complications
• Panniculitis/etiology
• Panniculitis/pathology

• Endoscopy
• Internal drainage
• Pancreatic pseudocyst
• Surgery

• Diagnostic Imaging/methods
• Disease Management
• Humans
• Pancreas/diagnostic imaging
• Pancreatic Cyst/classification
• Pancreatic Cyst/diagnosis
• Pancreatic Cyst/therapy
• Pancreatic Neoplasms/genetics
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/therapy

Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP), described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT) scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS) at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

• Chronic alcoholism
• Forensic pathology
• Pancreatitis
• Trauma

AIM: To compare surgical treatment versus endoscopic ultrasound-guided drainage for treatment of pancreatic pseudocysts regarding clinical success, complication rate, recurrence, hospital stay and cost.

METHODS: Seventy cases of pancreatic pseudocysts were retrospectively studied at our hospital from January 2012 through January 2015, of which 24 (group A) were drained under the guidance of endoscopic ultrasound and 46 (group B) were drained surgically. The clinical success, complication rate, recurrence, hospital stay and cost were compared between the two groups.

RESULTS: The complication rate was significantly lower in group A than in group B (12.5% vs 30.4%, P < 0.05). The hospital stay in group A was significantly shorter than that in group B (3.1 d ± 1.7 d vs 7.5 d ± 2.2 d, P < 0.05). Likewise, the cost was significantly lower in group A than in group B (1056 yuan ± 856 yuan vs 2349 yuan ± 457 yuan, P < 0.05). The clinical success, recurrence, and mortality rates were similar in both groups (P > 0.05).

CONCLUSION: Endoscopic treatment of pancreatic pseudocysts offers the same clinical success, recurrence, and mortality rates as surgical treatment but with a lower complication rate, and shorter hospital stay and lower costs.

• Pancreatic pseudocysts
• Endoscopic
• Surgical
• Hospital stay
• Costs

• Acute pancreatitis
• Chronic pancreatitis
• Endoscopic drainage
• Endoscopic ultrasound
• Pseudocyst
• Walled-off pancreatic necrosis

• Chronic pancreatitis
• Frey
• Neuropathic pain
• Puestow
• Surgery
• Total pancreatectomy

• Pancreas
• cystic lesions
• endoscopic ultrasonography (endoscopic US)
• intraductal papillary mucinous neoplasms (IPMNs)
• mucinous cyst
• pseudocyst

• Endoscopic drainage
• Endoscopic ultrasound guidance
• Pancreatic pseudocyst
• Surgical treatment

• Complications
• Drainage
• Outcomes
• Pseudocyst
• Treatment

• Drainage/adverse effects
• Drainage/methods
• Endoscopy, Digestive System/adverse effects
• Endoscopy, Digestive System/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Pancreatic Pseudocyst/diagnosis
• Pancreatic Pseudocyst/surgery
• Predictive Value of Tests
• Treatment Outcome

• Digestive System Surgical Procedures/methods
• Drainage/methods
• Female
• Humans
• Male
• Middle Aged
• Pancreatic Pseudocyst/classification
• Pancreatic Pseudocyst/therapy
• Postoperative Complications/epidemiology
• Tomography, X-Ray Computed

• R01 LM010923 NLM NIH HHS

• Disease Management
• Humans
• Pancreatitis, Chronic/complications
• Pancreatitis, Chronic/diagnosis
• Pancreatitis, Chronic/therapy

• Abdominal Pain/etiology
• Humans
• Infections/complications
• Male
• Middle Aged
• Pancreatic Pseudocyst/diagnostic imaging
• Pancreatic Pseudocyst/microbiology
• Point-of-Care Systems
• Ultrasonography

• Complication
• Distal pancreatosplenectomy
• Liver injury
• Pancreatic cancer
• Percutaneous catheter drainage

• Adolescent
• Adult
• Aged
• Biopsy
• Debridement/methods
• Drainage/methods
• Endosonography
• Female
• Follow-Up Studies
• Gastrostomy/methods
• Humans
• Laparoscopy/methods
• Male
• Middle Aged
• Mouth
• Natural Orifice Endoscopic Surgery/methods
• Pancreatic Pseudocyst/complications
• Pancreatic Pseudocyst/diagnosis
• Pancreatic Pseudocyst/surgery
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/etiology
• Pancreatitis, Acute Necrotizing/surgery
• Retrospective Studies
• Surgery, Computer-Assisted/methods
• Time Factors
• Young Adult

Despite multiple theories on the pathogenesis of pain in chronic pancreatitis, no uniform and consistently successful treatment strategy exists and abdominal pain still remains the dominating symptom for most patients and a major challenge for clinicians. Traditional theories focussed on a mechanical cause of pain related to anatomical changes and evidence of increased ductal and interstitial pressures. These observations form the basis for surgical and endoscopic drainage procedures, but the outcome is variable and often unsatisfactory. This underscores the fact that other factors must contribute to pathogenesis of pain, and has shifted the focus towards a more complex neurobiological understanding of pain generation. Amongst other explanations for pain, experimental and human studies have provided evidence that pain perception at the peripheral level and central pain processing of the nociceptive information is altered in patients with chronic pancreatitis, and resembles that seen in neuropathic and chronic pain disorders. However, pain due to e.g., complications to the disease and adverse effects to treatment must not be overlooked as an additional source of pain. This review outlines the current theories on pain generation in chronic pancreatitis which is crucial in order to understand the complexity and limitations of current therapeutic approaches. Furthermore, it may also serve as an inspiration for further research and development of methods that can evaluate the relative contribution and interplay of different pain mechanisms in the individual patients, before they are subjected to more or less empirical treatment.

• Chronic pancreatitis
• Abdominal pain
• Pain mechanisms
• Neuropathy
• Sensitization

• Abdominal Pain/etiology
• Abdominal Pain/physiopathology
• Abdominal Pain/psychology
• Abdominal Pain/therapy
• Animals
• Humans
• Pain Management/methods
• Pain Measurement
• Pain Perception
• Pain Threshold
• Pancreas/innervation
• Pancreatitis, Chronic/complications
• Pancreatitis, Chronic/physiopathology
• Pancreatitis, Chronic/psychology
• Pancreatitis, Chronic/therapy
• Risk Factors
• Treatment Outcome
• Visceral Afferents/physiopathology

• endoscopic pseudocystogastrostomy
• laparoscopic pseudocystogastrostomy
• pancreatic pseudocysts

• Acetaminophen/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Cholangiopancreatography, Endoscopic Retrograde
• Constriction, Pathologic/therapy
• Drainage
• Evidence-Based Medicine
• Exocrine Pancreatic Insufficiency/therapy
• Nutritional Status
• Pain Management
• Pancreatic Pseudocyst/therapy
• Pancreatitis, Chronic/diet therapy
• Pancreatitis, Chronic/surgery
• Pancreatitis, Chronic/therapy