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

Pai, Ganesh C and Suvarna, Deepak and Bhat, Ganesh (2009) Endoscopic treatment as first-line therapy for pancreatic ascites and pleural effusion. Journal of Gastroenterology and Hepatology, 24 (7). pp. 1198-1202.

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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.

Item Type: Article
Uncontrolled Keywords: pancreatitis, pancreatic ascites, pancreatic disease, pleural effusion, endoscopic stenting.
Subjects: Medicine > KMC Manipal > Gastroenterology
Depositing User: KMC Manipal
Date Deposited: 02 Apr 2012 06:32
Last Modified: 02 Apr 2012 06:32
URI: http://eprints.manipal.edu/id/eprint/3701

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