PhD Scientific Days 2025

Health Sciences III.

Clinical Outcomes and Safety of Endoscopic Transpapillary Pancreatic Duct Drainage for Pancreatic Pseudocysts: A Single-Center Tertiary Study

Name of the presenter

Váncsa Szilárd

Institute/workplace of the presenter

Institute of Pancreatic Diseases and Centre for Translational Medicine, Semmelweis University

Authors

Szilárd Váncsa¹, Dorottya Tarján¹, Emese Fürst², Krisztina Tari², Balázs Lázár², Péter Sahin², Péter J Hegyi², Péter Hegyi¹, Bálint Erőss¹

1: Institute of Pancreatic Diseases and Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
2: Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary

Text of the abstract

AIMS
Pancreatic pseudocysts with ductal abnormalities present a therapeutic challenge after the resolution of acute pancreatitis. This study evaluated the clinical outcomes and safety of primary ERCP transpapillary pancreatic duct drainage.
METHODS
In this retrospective single-center study, all patients undergoing ERCP transpapillary drainage for pancreatic pseudocysts at Semmelweis University between July 28, 2023, and October 17, 2024, were included. Procedures were performed by experts with >10 years of experience, using rectal indomethacin and IV Ringer lactate for post-ERCP pancreatitis prophylaxis. Data on baseline characteristics, procedure details, outcomes, and adverse events (graded by AGREE) were collected. Follow-up included outpatient visits and phone consultations. Results were expressed as proportions with 95% CIs or means with SD.
RESULTS
Fourteen procedures were performed in 12 patients (64% female, mean age 62.8±14.5 years). Indications included pseudocyst progression (n=12, 86%) and icterus/cholangitis (n=4, 26%). Mean pseudocyst dimensions were 62.5±40.5 mm (AP), 43.2±27.4 mm (LL), and 65.9±28.0 mm (CC). Procedural success was 64.3% (CI: 35.7%–85.7%), with failures due to Vater papilla cannulation issues; these cases were either followed up, re-attempted with ERCP, or treated with EUS-guided gastrocystostomy. Stents (4–7 Fr, 5–11 cm) were chosen based on pancreatography or cannulation difficulty. In successful cases, amylase and lipase decreased by 396.6±80.7 and 441.0±159.3 units, respectively, by day 7. One AGREE Grade IIIa adverse event occurred, managed intra-procedurally without further intervention. Mean procedure time was 34.2±13.6 minutes. Follow-up showed pseudocyst regression in 5 cases (1 complete), 1 EUS-guided drainage, and 4 pending follow-up. One patient required ICU care for pancreatitis-related multi-organ failure; no deaths occurred.
CONCLUSIONS
ERCP transpapillary drainage achieves moderate success in treating pancreatic pseudocysts, leading to symptom and enzyme improvement in successful cases. EUS-guided options remain essential for ERCP failure.