Cystogastrostomy for Pancreatic Cyst

Cystogastrostomy is an endoscopic outpatient surgery performed to drain a pancreatic pseudocyst that develops after acute or chronic pancreatitis. The pancreas produces hormones to regulate blood sugar, enzymes that help digest food, and bicarbonates that help neutralize stomach acid. Pancreatic ducts move these fluids into the upper part of the small intestine (duodenum).

Pancreatitis, or inflammation of the pancreas, can cause the pancreatic ducts to become blocked. As a result, fluid collects around the pancreas, forming a pancreatic pseudocyst. It is called a pseudocyst because it does not contain the type of cells found in true cysts.

While some pancreatic pseudocysts arise soon after acute or chronic pancreatitis, they often don't cause symptoms until weeks or months later. In fact, they’re usually found during imaging tests for another problem.

Most pancreatic pseudocysts aren't cancerous although they may change over time to become so. Your doctor might take a sample of the pancreatic cyst fluid to determine if cancer cells are present, or she might recommend monitoring it over time.

Doctors may use ERCP or endoscopic ultrasound with fine needle aspiration to diagnose pancreatic pseudocysts and test the fluid. If necessary, treatment can also be done during these procedures.

Not all cysts require treatment, such as those that are asymptomatic. Most resolve themselves over time. However, a pseudocyst that becomes larger than 6 centimeters in size needs to be drained. Those that cause symptoms or complications, such as abdominal pain, bloating, nausea or vomiting, poor digestion of food, infection and pancreatic abscess, rupture or bleeding of the pseudocyst, or intestinal blockages, will also require treatment.

Cystogastrostomy is performed to drain the pancreatic pseudocyst by creating an opening or inserting a stent between the cyst and the stomach.

How to Prepare for a Cystogastrostomy

You should not eat or drink anything after midnight prior to the procedure. Your doctor will let you know if or when you should adjust or stop any medications you take. Because you will be sedated, you will need someone to drive you home after the procedure.

What to Expect

At Austin Gastro, our gastroenterologists use endoscopy to treat a pancreatic pseudocyst in one of two ways:

• The doctor may create a small opening (fistula) between the pseudocyst and the stomach so that the fluid drains into the stomach.
• The doctor may insert a pancreatic stent between the cyst and the stomach or duodenum (upper part of small intestine), allowing the fluid to drain into the gastrointestinal tract.

You will lie on your left side for the procedure and receive sedation through an IV line to relax you and make you feel drowsy. A mouth guard will be placed to protect your teeth and gums. Your throat may also be numbed with a spray to calm the gag reflex. The doctor will insert the endoscope through the mouth, passing it down through the esophagus into the stomach.

Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier to see. A small camera mounted on the endoscope transmits live images to a video monitor. Special instruments are inserted through the endoscope to make the incision or to place the stent.

After the procedure, you will be taken to the recovery room while the sedative wears off. You may experience temporary discomfort, such as bloating, nausea, gagging, belching, or sore throat. Your doctor will discuss any unexpected side effects that may occur and a plan to address them.

If your doctor took a sample of the pancreatic cyst fluid, he will review your results during a follow-up appointment. It may take a few days to receive biopsy results. If any abnormal results were found, your doctor will discuss treatment plan options with you.