Abstracts submitted to ASGE 2010354: Randomized Trial Comparing EUS and Surgery for Pancreatic Pseudocyst Drainage
Section snippets
Background
Although EUS-guided cystogastrostomy is increasingly performed, surgery is still considered the gold standard technique for management of pancreatic pseudocysts (PC).
Aim
Compare treatment outcomes, quality of life (QOL) and costs between EUS and surgery for pancreatic cystogastrostomy.
Methods
Symptomatic patients with PC measuring > 6cm in size were randomized to undergo EUS-guided or surgical cystogastrostomy. Pancreatic abscess or necrosis, multiple PC and those PC located distant from the stomach were excluded. The primary endpoint was PC recurrence at 18 months. The secondary endpoints were pain pattern (measured by brief pain inventory), quality of life (assessed by SF-36), total costs, length of post-procedure hospital stay (LOS), complications and reinterventions at end of
Results
Of 90 screened patients, 36 met inclusion criteria and underwent randomization, 19 to EUS and 17 to surgery. There was no difference in patient demographics, clinical presentation, pseudocyst size, rates of technical (both cohorts, 100%) or treatment success (94.4% vs. 100%, p=1) and procedural complications (none in both cohorts) between EUS and surgery, respectively. At a median follow-up of 18 months, there was no difference in rates of PC recurrence (0% vs. 5.8%, p=0.48) or reinterventions
Conclusions
EUS-guided cystogastrostomy should be the preferred treatment approach for patients with uncomplicated symptomatic pancreatic pseudocysts as the procedure is less costly, yields quick pain relief, is associated with shorter length of hospital stay and has long-term clinical outcomes and quality of life comparable to that of surgery.