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Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: success and complication rates

Surgical Endoscopy volume 21, pages 1726–1732 (2007)Cite this article

Abstract

Background

Endoscopic drainage of pancreatic fluid collections (PFC) is performed with increasing frequency. A variety of techniques for performing transmural entry have been described. However, data are lacking on the technical success and safety of transmural entry using a single technique. The authors describe the largest experience in transmural entry of PFCs without endoscopic ultrasound (EUS) guidance using a dedicated aspiration needle.

Methods

All patients who underwent endoscopic transmural drainage of PFC from October 1998 to May 2006 were identified from the endoscopy database. Data were abstracted from the endoscopic procedure report and the patient records then placed in a JMP drive. All drainages were performed without EUS guidance after visualization of an obvious intraluminal bulge using a dedicated large-bore aspiration needle. The transmural tract into the PFC was dilated using a balloon with a diameter of 6 to 20 mm followed by subsequent placement of one or two 10-Fr double pigtail stents with or without nasocystic irrigation tubes. Successful entry was defined as entry allowing for the placement of stents.

Results

Total no. of patients 94
Gender (male/female) 50/44
Age (years): median (range) 49 (12–78)
Types of PFC
  • Organized pancreatic necrosis • 45
  • Pseudocyst (acute pancreatitis) • 25
  • Pseudocyst (chronic pancreatitis) • 19
  • Pancreatic abscess • 5
Size of PFC (cm): median (range) 11 (3–23)
Transmural drainage approach
  • Transgastric • 60
  • Transduodenal • 31
  • Transgastric and transduodenal • 2
  • Transpapillary • 1
Successful entry: n (%) 91 (97)
Complications: n (%)a 4 (4.2)
  • Clinically significant bleeding • 3
  • Perforation • 1 (gallbladder)
  1. a Required hospitalization, conservative management

No significant difference in the complication rates was observed when they were analyzed for the following variables: age, gender, balloon diameter, presence of endoscopic impression, drainage approach, and size and type of fluid collection.

Conclusion

Endoscopic transmural drainage of pancreatic fluid collections can be performed safely and effectively via the Seldinger technique without endoscopic ultrasound guidance. The study data will allow sample size calculations to be made if direct comparisons with this technique and others are undertaken.

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Acknowledgment

Dr. Baron is a consultant for Cook Endoscopy. He does not receive royalties from sales of the Baron needle.

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Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA

    P. Chahal, G. I. Papachristou & T. H. Baron

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  1. P. Chahal
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  2. G. I. Papachristou
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  3. T. H. Baron
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Correspondence to T. H. Baron.

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Chahal, P., Papachristou, G.I. & Baron, T.H. Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: success and complication rates. Surg Endosc 21, 1726–1732 (2007). https://doi.org/10.1007/s00464-007-9236-6

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  • DOI: https://doi.org/10.1007/s00464-007-9236-6

Keywords

  • Dedicated aspiration needle
  • Endoscopic drainage
  • Endoscopic transmural entry
  • Pancreatic fluid collections
  • Seldinger technique