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

C. Ganesh Pai, Deepak Suvarna, Ganesh Bhat

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1198-1202
Number of pages5
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume24
Issue number7
DOIs
Publication statusPublished - 01-01-2009

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Pleural Effusion
Ascites
Pancreatic Diseases
Therapeutics
Pancreatitis
Stents
Octreotide
Parenteral Nutrition
Chronic Pancreatitis
Amylases
Somatostatin
Alcoholism
Stomach Neoplasms
Hospitalization
Fever
Morbidity
Costs and Cost Analysis
Recurrence
Drug Therapy
Pain

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Hepatology

Cite this

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title = "Endoscopic treatment as first-line therapy for pancreatic ascites and pleural effusion",
abstract = "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.",
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Endoscopic treatment as first-line therapy for pancreatic ascites and pleural effusion. / Pai, C. Ganesh; Suvarna, Deepak; Bhat, Ganesh.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 24, No. 7, 01.01.2009, p. 1198-1202.

Research output: Contribution to journalArticle

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