Dual Drainage Cuts Pancreatic Stent Occlusion Rates

Drainage with a combination of nasocystic drain and transmural stent outperformed stents alone in treating debris-laden pancreatic pseudocysts, according to a new study.

Researchers at Thomas Jefferson University Hospital (Philadelphia, PA, USA) conducted a retrospective study involving 87 patients with pancreatic pseudocysts to compare the clinical outcomes of endoscopic ultrasonography (EUS) guided pseudocyst drainage, both with and without a nasocystic drain for management of pancreatic pseudocysts with viscous solid debris-laden fluid. In all, 63 patients with solid debris underwent drainage via nasocystic drains alongside stents, while 24 patients underwent drainage via transmural stents only. The primary outcomes were short- and long-term success of the procedures.

The results showed that patients whose pancreatic pseudocysts were drained via stent and nasocystic tubes had a significant threefold higher short-term success rate versus stents alone, as well as significantly lower rates of stent occlusion (13% versus 33%). Complete resolution of the debris-laden pseudocysts was more common among those treated with the tube and stent versus stent alone (79% versus 58%, respectively), though the difference was not significant. The study was published in the October 2013 issue of Gastrointestinal Endoscopy.

“Although the overall clinical success for effective pseudocyst decompression by endoscopic therapy is high, previous trials have demonstrated that the response depends on the type of pseudocyst,” said lead author Ali Siddiqui, MD, and colleagues. “Dual drainage with aggressive irrigation was shown to be an effective treatment for debris-laden viscous pancreatic cysts.”

Pseudocysts occur in 10%–20% of patients with acute pancreatitis, and in 20%–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. 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.

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