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

  • Shyam Varadarajulu
  • Ji Young Bang
  • Milind A. Phadnis
  • John D. Christein
  • C. Mel Wilcox
Original Article



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.


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.


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.


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


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


  1. 1.
    Bollen TL, van Santvoort HC, Besselink MG, van Leeuwen MS, Horvath KD, Freeny PC, Gooszen HG; Dutch Acute Pancreatitis Study Group. The Atlanta Classification of acute pancreatitis revisited. Brit J Surg 2008; 95: 6–21.PubMedCrossRefGoogle Scholar
  2. 2.
    Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc 2006; 63: 635–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Seewald S, Ang TL, Teng KCYK, Soehendra N. EUS-guided drainage of pancreatic pseudocysts, abscesses and infected necrosis. Digest Endosc 2009; 21 (Suppl. 1): S61-S65.CrossRefGoogle Scholar
  4. 4.
    Smits ME, Rauws EAJ, Tytgat GNJ, Huibregtse K. The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastrointest Endosc 1995; 42: 202–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Sahel J, Bastid C, Pellat B, Schurgers P, Sarles H. Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases. Pancreas 1987; 2: 447–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Cremer M, Deviere J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience. Gastrointest Endosc 1989; 35:1–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Ahn JY, Seo DW, Eum J Song TJ, Moon SH, Park do H, Lee SS, Lee SK, Kim MH. Single-step EUS-guided transmural drainage of pancreatic pseudocysts: analysis of technical feasibility, efficacy, and safety. Gut Liver 2010; 4: 524–529.PubMedCrossRefGoogle Scholar
  8. 8.
    Lopes CV, Pesenti C, Bories E, Caillol F, Giovannini M. Endoscopic-ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts and abscesses. Scand J Gastroentero 2007; 42: 524–529CrossRefGoogle Scholar
  9. 9.
    Kruger M, Schneider AS, Manns MP, Meier PN. Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access. Gastrointest Endosc 2006; 63: 409–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Antillon MR, Shah RJ, Stiegmann G, Chen YK. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest Endosc 2006; 63: 797–803.PubMedCrossRefGoogle Scholar
  11. 11.
    Varadarajulu S, Tamhane A and Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video). Gastrointest Endosc 2008; 68: 656–66.PubMedCrossRefGoogle Scholar
  12. 12.
    Baron TH, Harewood GC, Morgan DE, Yates MR. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 2002; 56: 7–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Weckman L, Kylänpää M-L, Puolakkainen P, Halttunen J. Endoscopic treatment of pancreatic pseudocysts. Surg Endosc 2006; 20: 603–607.PubMedCrossRefGoogle Scholar
  14. 14.
    Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M. Endoscopic drainage of pancreatic pseudocysts: Long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy 2005; 37(10): 977–983.PubMedCrossRefGoogle Scholar
  15. 15.
    Binmoeller KF, Seifert H, Walter A, Soehendra N. Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 1995; 42: 219–24.PubMedCrossRefGoogle Scholar
  16. 16.
    Sharma SS, Bhargawa N and Govil A. Endoscopic management of pancreatic pseudocyst: A long-term follow-up. Endoscopy 2002; 34: 203–207.PubMedGoogle Scholar
  17. 17.
    Beckingham IJ, Krige JEJ, Bornman PC, Terblanche J. Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 1999; 94: 71–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Varadarajulu S, Trevino J, Wilcox CM, Sutton B, Christein JD. Randomized trial comparing EUS and surgery for pancreatic pseudocyst drainage. Gastrointest Endosc 2010; 71: AB 116.Google Scholar
  19. 19.
    Varadarajulu S, Lopes TL, Wilcox CM, Drelichman ER, Kilgore ML, Christein JD. EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc 2008; 68:649–55.PubMedCrossRefGoogle Scholar
  20. 20.
    Bradley EL III. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 1993; 128 (5): 586–90.PubMedGoogle Scholar
  21. 21.
    van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362: 1491–1502.PubMedCrossRefGoogle Scholar
  22. 22.
    Seifert H, Biermer M, Schmitt W, Jürgensen C, Will U, Gerlach R, Kreitmair C, Meining A, Wehrmann T, Rösch T. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009; 1260–1266.Google Scholar
  23. 23.
    Ross A, Gluck M, Irani S, Hauptmann E, Fotoohi M, Siegal J, Robinson D, Crane R, Kozarek R. Combined endoscopic and percutaneous drainage of organized pancreatic necrosis. Gastrointest Endosc 2010; 71: 79–84.PubMedCrossRefGoogle Scholar
  24. 24.
    Adams DB, Harvey TS and Anderson MC. Percutaneous catheter drainage of infected pancreatic and peripancreatic fluid collections. Arch Surg 1990; 125: 1554–7.PubMedGoogle Scholar
  25. 25.
    Nealon WH, Bhutani M, Riall TS, Raju G, Ozkan O, Neilan R. A unifying concept: pancreatic ductal anatomy both predicts and determines the major complications resulting from pancreatitis. J Am Coll Surg 2009; 208: 790–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Arvanitakis M, Delhaye M, Bali MA Matos C, De Maertelaer V, Le Moine O, Devière J. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 2007; 65: 609–19.PubMedCrossRefGoogle Scholar
  27. 27.
    Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008; 68: 1102–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Varadarajulu S. EUS followed by endoscopic pancreatic pseudocyst drainage or all-in-one procedure: a review of basic techniques (with video). Gastrointest Endosc 2009; 69 (2 Suppl): S176-81.PubMedCrossRefGoogle Scholar
  29. 29.
    Varadarajulu S, Eloubeidi MA, Wilcox CM. The concept of bedside EUS. Gastrointest Endosc 2008; 67: 1180–4.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Shyam Varadarajulu
    • 1
    • 3
  • Ji Young Bang
    • 1
  • Milind A. Phadnis
    • 1
  • John D. Christein
    • 2
  • C. Mel Wilcox
    • 1
  1. 1.Division of Gastroenterology-HepatologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Basil I. Hirschowitz Endoscopic Center of ExcellenceUniversity of Alabama at BirminghamBirminghamUSA

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