Details

Autor(en) / Beteiligte

• Pai, C Ganesh
• Suvarna, Deepak
• Bhat, Ganesh

Titel

Endoscopic treatment as first-line therapy for pancreatic ascites and pleural effusion

Ist Teil von

• Journal of gastroenterology and hepatology, 2009-07, Vol.24 (7), p.1198-1202

Ort / Verlag

Melbourne, Australia: Blackwell Publishing Asia

Erscheinungsjahr

2009

Quelle

Wiley Online Library All Journals

Beschreibungen/Notizen

• Background:  Ascites and pleural effusion are well recognized complications of pancreatic diseases. Drug therapy of these is limited by high cost, prolonged hospitalization and failure rates; surgery is invasive and is associated with considerable morbidity and mortality. Objective:  To analyze the data on patients with pancreatic ascites and/or pleural effusion treated endoscopically over a ten‐year period. Methods:  Patients with symptomatic ascites/pleural effusion for at least 3 weeks with a fluid amylase level of > 1000 S units/dl and underlying pancreatic disease were included. The interventions were a 5 mm sized pancreatic sphincterotomy and placement of a 7 Fr pancreatic stent. Somatostatin/octreotide and parenteral nutrition were not used after endoscopic therapy. Results:  Of the 28 patients included (22 men), 17 (60.7%) had chronic pancreatitis. The causes were tropical pancreatitis (13, 46.4%), alcohol abuse (10, 35.7%), idiopathic acute pancreatitis (4, 14.3%) and resective surgery for gastric cancer (1, 3.6%). Ascites alone was seen in 15, pleural effusion alone in 6 and both in 7 patients. Ten patients (35.7%) had 14 pseudocysts. Endotherapy was successful in 27 (96.4%). Twenty‐six (92.8%) patients had complete resolution of ascites/effusion over a median 5 weeks. The stents were removed 3–6 weeks later without any recurrence over the next 6–36 (median = 17) months. Complications (7, 25%) included severe pain in 2 (7.1%) and fever in 5 (17.8%) of which 3 (10.7%) had infection of residual fluid collections. No patient died. Conclusion:  Endoscopic therapy offers an excellent therapeutic alternative in patients with pancreatic ascites and pleural effusion.