Endoscopy Pseudocyst Drainage

Overview

Pancreatic pseudocysts are caused by chronic pancreatic or acute pancreatitis. When pancreatic juice leaks out of a damaged pancreatic duct, it forms into a cyst around the pancreas. The cyst is composed of inflammatory debris and pancreatic secretions.

Most of the pseudocysts that are asymptomatic do not need any treatment. Certain pseudocysts, however, become infected and eventually rupture. A controlled rupture usually causes GI bleeding, while a free rupture produces acute abdominal pain, or any unavoidable circumstances.

A majority of pseudocysts do not require any treatment and get resolved without interference. Supportive care for a long duration helps to treat such small cysts. Enlarged cysts are likely to get complicated and become symptomatic and are treated with Endoscopic Psuedocyst Drainage (EPD).

There are other symptoms of Endoscopy Pseudocyst drainage rather than the mere size of the cyst. They include organ compression, acute abdominal pain, jaundice and gastric outlet obstruction.

Treatment of pseudocysts requires an expert team of invasive radiologist, surgeons and gastroenterologists. If the team feels that non-surgical endoscopic pseudocyst drainage is the right option, a thorough examination of the pancreatic duct is required beforehand. On the other hand, surgical drainage interventions like cyst-jejunostomy and cyst-gastrostomy are the standard treatments.

The diagnosis of pancreatic pseudocysts is done with a CT scan that shows a large mass full of fluid located around the pancreas. Pseudocysts are sometimes confused with mucinous cystadenoma since they look the same. Therefore, proper evaluation is needed to assess the severity of the cyst and its treatment options.

Using endoscopic guidance during pseudocyst drainage procedure is considered safe. EUS generates distinct images of the surrounding topographical anatomy of the pancreas and the pseudocyst. This enables doctors to perform the procedure without difficulty.

Before the Treatment

Before endoscopic pseudocyst procedure, there are specific instructions to be followed:

• Do not eat anything for at least 12 hours before EPD. During the procedure your stomach should be empty.
• Consult with your doctor and tell him about the medications you are on. Inform him about your health conditions, if any. Especially, those taking blood thinners are not allowed to take certain medicines, but they may be prescribed to take some other medicines.
• This is because blood thinners increase the risk of bleeding. Chronic conditions like high blood pressure and diabetes should be informed to the doctor, according to which you are advised medicines.
• Ask your surgeon about the possible risks associated with the procedure and the recoveries.
• Make arrangement of recovery beforehand. Learn from your doctor if the procedure is painful, and how long you will take to recover. Have a friend or relative to take you home after endoscopic pseudocyst drainage procedure.

How it is performed

Pseudocysts that are smaller than six centimetres disappear naturally without interventions, but cysts that are large, last over two months and show signs of complications are treated with EPD procedure.

• General anaesthesia is administered to help you sleep through the procedure. A small cut is done in the abdomen through which laparoscopic instruments are inserted.
• In case of laparoscopic procedure, three or four incisions are made. A tube-like instrument is inserted through the cut.
• To enable better visual viewing of the abdominal cavity, the abdomen is filled with gas.
• Additional instruments are inserted through other tubes. Since the procedure is done with small incisions, no large cut is required.
• A camera is inserted through the tubes to take clearer pictures of the abdomen that are displayed on the computer monitor.
• The surgeon makes an incision to get access to the cyst.
• A needle inserted through one of the cuts is used to puncture the cyst for drainage. If the cyst is large, then a tube or drain is left inside for a few days to allow secretion and fluid gets drained out from the cyst.
• There are possible chances of infections, bleeding, or adverse reactions to general anaesthesia, but the doctor takes care of the situation instantly with additional procedures.
• If the pseudocyst is not properly drained, it may result into a pancreatic abscess.

Recovery

• After the procedure, you are transferred to the post-operative recovery unit, where you may feel tired after the effects of anaesthesia wears off. The nurse, however, monitors your recovery progress.
• There are feelings of discomfort at the cut site, so you are prescribed pain killers. Have someone by your side to drive you home on the day of surgery.
• The recovery of Endoscopic Pseudocyst Drainage procedure takes a few days, and after that you can return to normal activities like driving, showering, walking and light lifting. However, listen to your doctor when to return to work. It is advised not to engage in strenuous activities and heavy lifting tasks for 6-8 weeks.
• Do not miss your follow-up schedule post surgery, since your doctors evaluates your condition and decides how you are now.
• In case of persistent pain and chill, call your doctor right away.