Current treatment of pancreatic pseudocysts: a systematic review

Abstract

Background. Pancreatic pseudocysts stand among current challenges in modern medicine. Their treatment uses variant instrumental techniques and implies a multispecialty approach. Trials in surgery and gastroenterology have aimed to identify an optimal strategy to tackle pancreatic pseudocysts for reducing complications and the recurrence rate, suggesting ultrasound-guided percutaneous, laparoscopic and flexible endoscopic drainage as promising treatment choices.Objectives. A summarising review of diagnostic and therapeutic methods for pancreatic pseudocyst treatment and comparison of ultrasound-guided percutaneous vs. surgical and endoscopic drainage techniques.Methods. The review examines the classification, epidemiology and methods for diagnosis and treatment of pancreatic pseudocysts. Only comparative full-text studies published within 2014–2021, as well as selected impactive publications within 2002–2013, have been included. The eLibrary, Elsevier and PubMed resources were queried for the article or journal title fields against the keywords (separate or combined) “pancreatic pseudocyst” [псевдокиста поджелудочной железы], “pseudocyst drainage” [дренирование псевдокисты], “surgical drainage” [хирургическое дренирование], “endoscopic drainage” [эндоскопическое дренирование], cystogastrostomy [цистогастростомия], gastrojejunostomy [гастроеюностомия], “duodenal-cystic anastomosis” [цистодуоденоанастомоз], “transpapillary drainage” [транспапиллярное дренирование], “transmural drainage and esophagogastroduodenoscopy” [трансмуральное дренирование и эзофагогастродуоденоскопия]. Records have been selected for topic-related scientific value.Results. The review systematically surveys 68 scientific papers in the focus area and summarises the most common surgical methods for pancreatic pseudocyst treatment. Based on the main principle, the methods are classified into three categories, ultrasound-guided percutaneous drainage, surgical drainage and flexible endoscopic drainage. The major classifications and treatment techniques are highlighted for their advantages and disadvantages.Conclusion. There exist no generally adopted strategy for pancreatic pseudocyst treatment in current clinical practice and no evidence on a particular method application in a large patient cohort. The publication survey identifies the techniques of percutaneous, surgical and endoscopic drainage with ultrasound control as highly effective overall among other surgical treatments.