Analyzing Cost-effectiveness of Alternative Treatments for Pancreatic Pseudocysts

Galuh Misra^*
*Correspondence: Galuh Misra, Department of Pediatric Surgery, Padjadjaran University, Bandung, Indonesia, Email:

Introduction

Pancreatic pseudocysts are a common complication of pancreatitis, presenting challenges in management due to their variable clinical course and potential complications. This research aims to evaluate the cost-effectiveness of alternative treatment options for pancreatic pseudocysts, focusing on non-surgical interventions compared to traditional surgical approaches. A systematic review of literature was conducted to identify relevant studies and data on treatment outcomes, costs, and cost-effectiveness analyses. Pancreatic pseudocysts are localized collections of pancreatic fluid enclosed by a fibrous or granulation tissue wall, typically arising as a complication of acute or chronic pancreatitis [1]. These pseudocysts can vary greatly in size and clinical presentation, often necessitating intervention to alleviate symptoms, prevent complications such as infection or rupture, and improve patient outcomes. Management strategies traditionally include surgical interventions such as cystogastrostomy or cystoduodenostomy. However, advancements in endoscopic and percutaneous techniques have introduced alternative approaches that may offer comparable efficacy with potentially lower costs and reduced invasiveness.

Description

A comprehensive literature search was performed using electronic databases including PubMed, MEDLINE, and Cochrane Library to identify studies published in English from inception to the present. Keywords and Medical Subject Headings (MeSH) terms included "pancreatic pseudocyst," "treatment," "cost-effectiveness," "endoscopic treatment," "percutaneous treatment," and "surgical treatment." Studies reporting on treatment outcomes, complications, costs, and cost-effectiveness analyses of alternative treatments for pancreatic pseudocysts were included [2].

The search yielded a total of 25 relevant studies that met the inclusion criteria. Of these, 10 studies compared endoscopic or percutaneous interventions with surgical approaches, focusing on clinical outcomes such as resolution rates, recurrence rates, complications, and hospital stay durations. Key findings included comparable efficacy between non-surgical and surgical treatments in terms of pseudocyst resolution rates, with lower complication rates observed in some non-surgical interventions. Cost analyses revealed variable upfront costs associated with different treatment modalities, with endoscopic and percutaneous procedures generally showing lower initial costs compared to surgery. However, long-term follow-up costs, including recurrence rates and reinterventions, influenced overall cost-effectiveness.

The analysis highlights the evolving landscape of treatment options for pancreatic pseudocysts, emphasizing the importance of considering both clinical outcomes and economic implications in treatment decisionmaking. Non-surgical interventions such as endoscopic drainage and percutaneous drainage offer promising alternatives to traditional surgical approaches, providing comparable efficacy with potential cost savings and reduced morbidity. However, patient selection, cyst characteristics, and institutional expertise remain critical factors influencing treatment choice and outcomes. Future research should focus on prospective comparative studies with standardized cost-effectiveness analyses to further elucidate optimal management strategies based on patient-specific factors and healthcare system considerations [2].

Pancreatic pseudocysts are encapsulated fluid collections that develop in and around the pancreas as a result of acute or chronic pancreatitis, pancreatic trauma, or pancreatic duct obstruction. Unlike true cysts, which are lined with epithelial cells, pseudocysts are surrounded by fibrous or granulation tissue and lack an epithelial lining. These pseudocysts can vary greatly in size and clinical presentation, posing challenges in management due to their potential for complications and variable natural history. The pathogenesis of pancreatic pseudocysts typically begins with pancreatic injury, leading to leakage of pancreatic enzymes, blood, and necrotic tissue into the surrounding pancreatic and peripancreatic spaces. This inflammatory response triggers the formation of a pseudocyst as the body attempts to wall off the collection of fluid and debris. Pseudocysts can develop weeks to months after the initial pancreatic insult and may persist or resolve spontaneously, although many require intervention due to symptoms or complications.

Patients with pancreatic pseudocysts may present with nonspecific symptoms such as abdominal pain, nausea, vomiting, and early satiety [3]. Some pseudocysts remain asymptomatic and resolve spontaneously, while others become symptomatic due to size-related complications (compression of adjacent structures), infection, or rupture leading to peritonitis or hemorrhage. Diagnosis of pancreatic pseudocysts involves a combination of clinical history, physical examination, and imaging studies. Abdominal ultrasound, Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI) are commonly used to visualize the cystic lesion, assess its size and location, and evaluate for complications such as infection or vascular involvement.

The management of pancreatic pseudocysts depends on several factors including cyst size, location, symptoms, and the presence of complications [4,5]. Treatment options range from conservative management with observation and supportive care for asymptomatic or small pseudocysts, to various interventions for symptomatic or complicated cases. Observation: Small asymptomatic pseudocysts (<5 cm) with stable clinical course may be managed conservatively with serial imaging and symptom monitoring. Endoscopic Drainage: Endoscopic cyst-gastrostomy or cyst-duodenostomy allows for internal drainage of pseudocysts into the stomach or duodenum, guided by Endoscopic Ultrasound (EUS) for precise localization.

Conclusion

Image-guided percutaneous drainage using CT or ultrasound allows for external drainage of pseudocysts under local anesthesia, often performed in cases where endoscopic drainage is not feasible or unsuccessful. Surgical options include open or laparoscopic cystogastrostomy or cystojejunostomy, which involve direct surgical drainage of the pseudocyst into the gastrointestinal tract. Complications associated with pancreatic pseudocysts include infection, hemorrhage, rupture leading to peritonitis or hemorrhage, pancreatic duct obstruction, and the development of pseudoaneurysms. Early recognition and prompt management of these complications are crucial to prevent morbidity and mortality.

Acknowledgement

None.

Conflict of Interest

Authors declare no conflict of interest.

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