Zusammenfassung
Pankreaspseudozysten nach akuter oder bei chronischer Pankreatitis sind häufig. Meist bilden sie sich spontan zurück und bedürfen keiner Behandlung. Pseudozysten, die Symptome verursachen oder zu Komplikationen führen, sollten entweder endoskopisch-interventionell oder chirurgisch behandelt werden. Asymptomatische Pseudozysten können behandelt werden, wenn sie sich innerhalb von sechs Wochen nicht zurückbilden oder größer als 5 cm im Durchmesser messen. Grund für die Behandlung ist die hohe Komplikationsrate großer Pseudozysten, auch wenn sie noch keine Symptome verursachen. Die Einschätzung von Pankreaspseudozysten erfolgt am besten mittels EUS. Ebenso sollte eine endoskopisch-interventionelle Drainage nur unter EUS-Kontrolle erfolgen. Eine Pseudozystendrainage sollte immer unter antibiotischer Abschirmung erfolgen.
Literatur
Aghdassi A, Mayerle J, Kraft M et al (2008) Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas 36:105–112
Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984) Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 86:820–828
Andrén-Sandberg A, Ansorge C, Eiriksson K, Glomsaker T, Maleckas A (2005) Treatment of pancreatic pseudocysts. Scand J Surg 94(2):165–175
Balthazar EJ, Freeny PC, van Sonnenberg E (1994) Imaging and intervention in acute pancreatitis. Radiology 193:297–306
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group (2013) Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–11
Barthet M, Sahel J, Bodiou-Bertei C, Bernard JP (1995) Endoscopic transpapillary drainage of pancreatic pseudocysts. Gastrointest Endosc 42:208–213
Barthet M, Lamblin G, Gasmi M et al (2008) Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc 67:245–252
Bradley EL, Gonzalez AC, Clements JL Jr (1976) Acute pancreatic pseudocysts: incidence and implications. Ann Surg 184:734–737
Bradley EL, Clements JL Jr, Gonzalez AC (1979) The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 137:135–141
Brugge WR, Lewandrowski K, Lee-Lewandrowski E et al (2004) Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 126:1330–1336
Bülow R, Simon P, Thiel R, Thamm P, Messner P, Lerch MM, Mayerle J, Völzke H, Hosten N, Kühn JP (2014) Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population. Eur Radiol 24:3142–3149
Ellis I, Lerch MM, Whitcomb DC (2001) Genetic testing for hereditary pancreatitis: guidelines for indications, counselling, consent and privacy issues. Pancreatology 1:405–415
Gouyon B, Levy P, Ruszniewski P et al (1997) Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis. Gut 41:821–825
Gress TM, Müller-Pillasch F, Lerch MM, Friess H, Büchler M, Beger HG, Adler G (1994) Balance of expression of genes coding for extracellular matrix proteins and extracellular matrix degrading proteases in chronic pancreatitis. Z Gastroenterol 32:221–225
Hernández CA, Lerch MM (1993) Sphincter stenosis and gallstone migration through the biliary tract. Lancet 341:1371–1373
Hirano T, Saluja A, Ramarao P, Lerch MM, Saluja M, Steer ML (1991) Apical secretion of lysosomal enzymes in rabbit pancreas occurs via a secretagogue regulated pathway and is increased after pancreatic duct obstruction. J Clin Invest 87:865–869
Hoffmeister A, Mayerle J, Beglinger C, Büchler MW, Bufler P, Dathe K, Fölsch UR, Friess H, Izbicki J, Kahl S, Klar E, Keller J, Knoefel WT, Layer P, Loehr M, Meier R, Riemann JF, Rünzi M, Schmid RM, Schreyer A, Tribl B, Werner J, Witt H, Mössner J, Lerch MM (2012) S3-Consensus guidelines on definition, etiology, diagnosis and medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol 50:1176–1224
Keim V, Bauer N, Teich N, Simon P, Lerch MM, Mössner J (2001) Clinical characterization of patients with hereditary pancreatitis and mutations in the cationic trypsinogen gene. Am J Med 111:622–626
Krüger B, Lerch MM, Tessenow W (1998) Direct detection of premature protease activation in living pancreatic acinar cells. Lab Invest 78:763–764
Lehman GA (1999) Pseudocysts. Gastrointest Endosc 49:S81–S84
Lerch MM (2013) Classifying an unpredictable disease: the revised Atlanta classification of acute pancreatitis. Gut 62(1):2–3
Lerch MM, Weidenbach H, Hernandez CA, Preclik G, Adler G (1994) Pancreatic outflow obstruction as the critical event for human gall stone induced pancreatitis. Gut 35:1501–1503
Lerch MM, Lutz MP, Weidenbach H, Muller-Pillasch F, Gress TM, Leser J, Adler G (1997) Dissociation and reassembly of adherens junctions during experimental acute pancreatitis. Gastroenterology 113:1355–1366
Lerch MM, Stier A, Wahnschaffe U, Mayerle J (2009) Pancreatic pseudocysts: observation, endoscopic drainage, or resection? Dtsch Arztebl Int 106:614–621
Linder JD, Geenen JE, Catalano MF (2006) Cyst fluid analysis obtained by EUS-guided FNA in the evaluation of discrete cystic neoplasms of the pancreas: a prospective single-center experience. Gastrointest Endosc 64:697–702
Maléth J, Balázs A, Pallagi P, Balla Z, Kui B, Katona M, Judák L, Németh I, Kemény LV, Rakonczay Z Jr, Venglovecz V, Földesi I, Pető Z, Somorácz Á, Borka K, Perdomo D, Lukacs GL, Gray MA, Monterisi S, Zaccolo M, Sendler M, Mayerle J, Kühn JP, Lerch MM, Sahin-Tóth M, Hegyi P (2015) Alcohol disrupts levels and function of the cystic fibrosis transmembrane conductance regulator to promote development of pancreatitis. Gastroenterology 148:427–439
Maringhini A, Uomo G, Patti R et al (1999) Pseudocysts in acute nonalcoholic pancreatitis: incidence and natural history. Dig Dis Sci 44:1669–1673
Mayerle J, Schnekenburger J, Krüger B, Kellermann J, Ruthenbürger M, Weiss FU, Nalli A, Domschke W, Lerch MM (2005) Extracellular cleavage of E-cadherin by leukocyte elastase during acute experimental pancreatitis in rats. Gastroenterology 129:1251–1267
Mayerle J, Hoffmeister A, Werner J, Witt H, Lerch MM, Mössner J (2013) Chronic pancreatitis–definition, etiology, investigation and treatment. Dtsch Arztebl Int 110(22):387–393
Megibow AJ, Baker ME, Gore RM, Taylor A (2011) The incidental pancreatic cyst. Radiol Clin North Am 49:349–359
Nealon WH, Walser E (2003) Duct drainage alone is sufficient in the operative management of pancreatic pseudocyst in patients with chronic pancreatitis. Ann Surg 237:614–620
Neoptolemos JP (1993) Acute pancreatitis. Lancet 342:1061
NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. (2002) NIH Consens State Sci Statements 19:1–26
Pickartz T, Mayerle J, Lerch MM (2007) Autoimmune pancreatitis. Nat Clin Pract Gastroenterol Hepatol 4:314–323
Pohle T, Konturek JW, Domschke W, Lerch MM (2003) Spontaneous flow of bile through the human pancreatic duct in the absence of pancreatitis: nature’s human experiment. Endoscopy 35:1072–1075
Spinelli KS, Fromwiller TE, Daniel RA et al (2004) Cystic pancreatic neoplasms: observe or operate. Ann Surg 239:651–657
Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM (2008) Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 68:1102–1111
Werner J, Bartosch-Härlind A, Andersson R (2011) Cystic pancreatic lesions: current evidence for diagnosis and treatment. Scand J Gastroenterol 46:773–788
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag Berlin Heidelberg
About this entry
Cite this entry
Lerch, M.M., Mayerle, J., Simon, P. (2015). Chronische Pankreatitis: Behandlung von Pseudozysten. In: Lehnert, H., et al. SpringerReference Innere Medizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54676-1_550-1
Download citation
DOI: https://doi.org/10.1007/978-3-642-54676-1_550-1
Received:
Accepted:
Published:
Publisher Name: Springer, Berlin, Heidelberg
Online ISBN: 978-3-642-54676-1
eBook Packages: Springer Referenz Medizin