Effects of long-term parenteral nutrition on the course of pancreatic pseudocyst

The benefit of total parenteral nutrition (TPN) for the non-operative treatment of acute pancreatic pseudocyst remains hypothetical benefit. We reviewed results for 40 patients with pancreatic pseudocyst treated with TPN who had had serial imaging studies. On presentation, mean cyst size was 7.4 cm and after non-operative treatment with TPN (mean 32.5 days) the cyst had decreased to 5.6 cm. After the non-operative period, 68% of the pseudocysts had regressed, completely in 14% and partially in 54% of the patients. Except for 1 patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) of the patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complications, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), during the course of hospitalization. Most of the patients treated with TPN showed both clinical and radiographic regression of their pseudocysts. However, the risk of catheter-related complications in this group suggests that this therapy should be limited to those patients who are unable to sustain enteral nutrition.