Original Article

Journal of Gastrointestinal Surgery

, 15:2080

First online:

Endoscopic Transmural Drainage of Peripancreatic Fluid Collections: Outcomes and Predictors of Treatment Success in 211 Consecutive Patients

  • Shyam VaradarajuluAffiliated withDivision of Gastroenterology-Hepatology, University of Alabama at BirminghamBasil I. Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham Email author 
  • , Ji Young BangAffiliated withDivision of Gastroenterology-Hepatology, University of Alabama at Birmingham
  • , Milind A. PhadnisAffiliated withDivision of Gastroenterology-Hepatology, University of Alabama at Birmingham
  • , John D. ChristeinAffiliated withDepartment of Surgery, University of Alabama at Birmingham
  • , C. Mel WilcoxAffiliated withDivision of Gastroenterology-Hepatology, University of Alabama at Birmingham

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Abstract

Objectives

Endoscopy is a minimally invasive technique for the drainage of peripancreatic fluid collections. This study evaluated the clinical outcomes and predictors of treatment success in consecutive patients undergoing endoscopic transmural drainage of peripancreatic fluid collections.

Methods

This is a retrospective study of patients who underwent endoscopic drainage of peripancreatic fluid collections over 7 years. Prior to drainage, an ERCP was attempted for stent placement in all patients with a pancreatic duct leak. Drainages were performed using conventional endoscopy or endoscopic ultrasound. Transmural stents and/or drainage catheters were deployed and endoscopic necrosectomy was undertaken when required. Data on clinical outcomes and complications were collected prospectively.

Results

A total of 211 patients underwent drainage of peripancreatic fluid collections that was classified as pseudocyst in 45%, abscess in 28%, and necrosis in 27%. Mean diameter of the fluid collection was 100.6 mm, and 34.5% of patients had pancreatic duct stent placement. Median duration of follow-up was 356 days. Treatment success was 85.3% and was higher for pseudocyst and abscess compared to necrosis (93.5% vs. 63.2%, p < 0.0001). Complications were encountered in 17 patients (8.5%) and was higher for drainage of necrosis than pseudocyst or abscess (15.8% vs. 5.2%, p = 0.02). Treatment success was more likely for patients with pseudocyst or abscess than necrosis (adjusted OR = 7.6, 95% CI [2.9, 20.1], p < 0.0001) when adjusted for serum albumin and white cell count, type of endoscopic modality or accessory used, pancreatic duct stenting, luminal compression, size and location of fluid collection.

Conclusions

Endoscopic therapy is a highly effective technique for the management of patients with non-necrotic peripancreatic fluid collections.

Keywords

Endoscopic drainage Endoscopic ultrasound-guided drainage EUS Pancreatic fluid collections Pancreatic pseudocysts Pancreatic necrosis Pancreatic abscess