Pancreatic pseudocyst: the controversial value of total parenteral nutrition.

BACKGROUND/AIMS: Total parenteral nutrition (TPN) for the non-operative treatment of acute pancreatic pseudocyst has been of hypothetical benefit.

MATERIALS AND

METHODS

We reviewed pseudocyst hospital admissions in 40 patients treated with TPN who had serial imaging studies. The mean cyst size was 7.4 cm on presentation, decreasing to 5.6 cm after non-operative treatment with TPN (mean 32.5 days).

RESULTS

After a non-operative period, 68 percent of pseudocysts regressed, completely in 14 percent, partially in 54 percent. Except for a patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complication, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), in the course of hospitalisation.

CONCLUSION

The majority of TPN-related patients had a clinical and radiographic regression of their pseudocysts. However, the increased risk of catheter-related complications in this group suggests that this therapy should be limited to patients who are unable to sustain enteral nutrition.