Original Article
Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes

https://doi.org/10.1016/j.gie.2005.06.028Get rights and content

Background

Pancreatic-fluid collections are frequent sequelae of acute and chronic pancreatitis, and endoscopic drainage of these collections has gained acceptance as an alternative to surgical drainage.

Methods

Patient data, collection characteristics, drainage technique, and outcomes were obtained through chart review and prospective follow-up for 116 patients with attempted endoscopic drainage of symptomatic pancreatic-fluid collections.

Results

A total of 116 patients presented with fluid collections classified as acute fluid collection (n = 5), necrosis (n = 8), acute pseudocyst (n = 30), chronic pseudocyst (n = 64), and pancreatic abscess (n = 9). The median diameter of the collection drained was 60 mm (15-275 mm). Median follow-up after drainage was 21 months. The drainage technique was transpapillary in 15 patients, transmural in 60, and both in 41. Successful resolution of symptoms and collection occurred in 87.9% of cases. No difference in success rates was observed between patients with acute pancreatitis and those with chronic pancreatitis. However, drainage of organized necrosis was associated with a significantly higher failure rate than other collections. No significant differences were observed regarding success when disease, drainage technique, or site of drainage was considered. Complications occurred in 13 patients (11%), and there were 6 deaths in the 30 days after drainage, including one that was procedure related.

Conclusions

Endoscopic drainage of pancreatic-fluid collections is successful in the majority of patients and is accompanied by an acceptable complication rate.

Section snippets

Patients and methods

All attempted endoscopic pancreatic-fluid collection drainages between January 1999 and December 2003 were identified by review of an examination log that contains a record of all therapeutic biliary and pancreatic endoscopy procedures. This period was chosen, because it was after the introduction of therapeutic echoendoscopes, which allow EUS-guided transmural drainage of PFC, including nasocystic and/or stent placement, without the need to exchange endoscopes (except for placement of large

Results

Etiology of the collections included AP (n = 47), CP (n = 66), and pancreatic surgery for benign tumors (n = 3). Baseline characteristics of the patients with AP and CP are shown in Table 1. Patients with CP had significantly lower body mass index (AP vs. CP, 24.1 vs. 20.2, p < 0.0001) and C-reactive protein before the procedure (AP vs. CP, 12.2 vs. 1.8 mg/dL, p < 0.0001) than AP patients. Three patients underwent drainage of collections that occurred because of ductal disruption after surgical

Discussion

Although drainage of PFCs can be performed by endoscopic, surgical, and/or percutaneous means, only by using endoscopy do we have the potential to perform an effective internal drainage with a rapid recovery time and, in addition, provide the option of pancreatic-duct drainage. While several reports have suggested similar success rates with open surgical drainage, it seems to be at the cost of higher mortality and morbidity rates.11, 12, 23, 24, 25 The exception to this may be patients with CP

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    L. Hookey receives support from the Canadian Association of Gastroenterology/Solvay/CIHR research fellowship.

    See CME section; p. 677.

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