PANCREATIC PSEUDOCYSTS - DEVELOPMENT OF THERAPEUTIC APPROACHES

Objective: To reassess the therapeutic options for pancreatic pseudocysts, resulting from the refinement of imaging techniques of the pancreas over the past 15 years. Data Sources: An extensive review of the literature for the period 1970 to 1994. When pertinent, the authors' experience with 45 patients was added to the literature data. Study Criteria: In the literature review the following selection criteria were used: diagnostic modalities (clinical, endoscopic and radiologic); clinical context (etiology and clinical presentation); and therapeutic modalities (observation and drainage). Data Extraction and Synthesis: Data collection was retrospective in most series. Whenever possible data collected before 1980 were differentiated from those collected after 1980 because diagnostic modalities were quite different in these two periods. Conclusions: Pancreatic pseudocysts are now diagnosed with more certainty and followed with more precision. Long-term observation is a safe and valuable approach. In symptomatic patients, some form of drainage should be considered. In an elective situation, internal drainage (endoscopic or surgical) is favoured. Cystogastrostomy should not be associated with an increased risk of bleeding.