Case Report

Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature

Table 1

Characteristics of the most reported giant pancreatic pseudocysts (largest dimension of at least 10 cm) in the literature.

Study referenceAgeSexPresentationCause of the pseudocystPleural effusionTime after pancreatitisWBCAmylaseLipaseCEA and CA19-9Cyst size on CT or US in cm (largest dimension)DiagnosisManagementComplicationsSecond drainage neededDischarge timeType of stent usedTime of stent removal after EUSNecrosectomy needed

[12]33FAbdominal pain
Abdominal distention
Anorexia
Acute pancreatitisNormalElevatedNormal10.3  9.6  9.3Abdominal computed tomography (CT)Open retrogastric cystogastrostomyNoDay 7
[13]65MAbdominal pain
Abdominal distention
Anorexia
Weight loss
Acute pancreatitisElevatedElevatedNormal25.7  15.3  10.9Abdominal computed tomography (CT)Open retrogastric cystogastrostomyYes (bleeding in day 4 POD)Day 6
[14]16MAbdominal pain
Abdominal distention
Dyspnea
Yes (bilateral)Elevated35  15  14Diagnostic laparoscopyLaparotomy (excision of the pseudocyst and Roux-en-Y pancreaticojejunostomy)No
[15]56MAbdominal pain
Abdominal distension
Abdominal mass
Acute pancreatitisYes (right)6 weeks25  17Abdominal computed tomography (CT)Open cystogastrostomyNo10 pod
[16]63FAbdominal distentionAcute pancreatitis6 weeks12Abdominal computed tomography (CT)Open cystogastrostomyNo8 pod
[17]39MAbdominal painAcute pancreatitisElevatedElevated10  8Abdominal computed tomography (CT)Laparoscopic cystogastrostomyNo21 pod
[18]37FAbdominal pain
Abdominal mass
Acute pancreatitis12 weeksNormal23  15  12Abdominal computed tomography (CT)Laparoscopic transgastric cystogastrostomyYes (pseudocyst infection)9 pod
[19]18MAbdominal massAbdominal trauma22  18Abdominal computed tomography (CT)Laparoscopic transgastric cystogastrostomyNo12 pod
[20]49MAcute pancreatitisElevatedNormal10  4Abdominal computed tomography (CT)Laparoscopic cystogastrostomyNo
[21]48MAbdominal pain
Abdominal mass
Anorexia
Early satiety
Weight loss
Chronic pancreatitisNormalElevatedElevatedNormal21Abdominal computed tomography (CT)CT-guided percutaneous drainageNo
[22]61MAcute pancreatitisElevatedElevated13Abdominal computed tomography (CT)EUS-guided drainageYes (recurrence)YesMetallic stent8 weeksYes
[22]65MAbdominal painChronic pancreatitisElevated10  8.2  4.6Abdominal computed tomography (CT)EUS-guided drainageNoNo6 daysMetallic stent6 weeksNo
[22]61FAbdominal painAcute pancreatitisElevated14Abdominal computed tomography (CT)EUS-guided drainageYes (recurrence)Yes10 days1-metallic stent
2-plastic double-pigtail stent
No
[22]53MAbdominal pain
Vomiting
Acute pancreatitis7 weeksElevatedElevated10  12  8.7Abdominal computed tomography (CT)EUS-guided drainageNoNo6 daysMetallic stent2 weeksNo
[23]50MAbdominal pain
Abdominal mass
Vomiting
Acute pancreatitisYes (right)20 weeksNormalElevated12.7  10.8Abdominal US
Abdominal computed tomography (CT)
EUS-guided drainageNoNo7 daysNo
[24]37MAbdominal painAcute pancreatitis4 weeksNormalElevatedNormal10  7Abdominal USEUS-guided drainageNoNoSame dayPlastic double-pigtail stentNo
[24]54FAbdominal pain
Fever
Acute pancreatitisNormalElevatedElevatedNormal12  7  8Abdominal computed tomography (CT)EUS-guided drainageNoNoPlastic double pigtail stent3 weeksNo
[25]54FAbdominal painAcute pancreatitis3 weeksNormal13  14Abdominal computed tomography (CT)EUS-guided drainageYes (stent migration into pseudocyst)NoSame dayLumen-apposing metal stent5 weeksNo
[26]81MAbdominal painAcute pancreatitisNo4 weeksElevated17  11Abdominal computed tomography (CT)EUS-guided drainageYes (recurrence)YesPlastic double-pigtail stent8 weeksNo
[27]74MAbdominal pain
Fever
Chronic pancreatitisYes (bilateral)10Abdominal computed tomography (CT)EUS-guided drainageNoNoSame dayPlastic double-pigtails stentNo
[3]27MAbdominal pain
Abdominal distention
Weight loss
Anorexia
Acute pancreatitisYes (right)8 weeksNormalElevated30  15  14Abdominal computed tomography (CT)EUS-guided drainageYes (recurrence)Yes (after 1 week)Same day1-lumen-apposing metal stent
2-plastic double-pigtail stent
3 weeksNo
[28]69MAbdominal pain
Abdominal mass
Chronic pancreatitis1 yearNormalNormalElevated18Abdominal computed tomography (CT)EUS-guided drainageYes (pseudocyst infection, stent migration, and recurrence)YesSame dayPlastic double-pigtail stent8 weeksYes
This study63FAbdominal pain
Abdominal mass
Vomiting
Acute pancreatitisYes (left)3 weeksNormalElevatedNormalNormal15  15  12Abdominal computed tomography (CT)EUS-guided drainageNoNoSame day1-lumen-apposing metal stent
2-plastic double-pigtail stent
9 weeksYes
This study37FAbdominal pain
Abdominal distension
Vomiting
Early satiety
Acute pancreatitisYes (left)4 weeksNormalNormalElevatedNormal20  15  8Abdominal computed tomography (CT)EUS-guided drainageNoNoSame day1-lumen-apposing metal stent
2-plastic double-pigtail stent
6 weeksNo