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Efficacy and safety of endoscopic ultrasound guided drainage of pseudocysts and walled-off necrosis after failure of percutaneous drainage

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Abstract

Background

Endoscopic Ultrasound (EUS) represents the gold standard for initial drainage of pancreatic fluid collections (PFC) due to various etiologies. However, data concerning salvage EUS drainage after initial percutaneous drainage are limited. The purpose of our study was to evaluate the clinical outcomes and safety of EUS-guided drainage of pancreatic collections after failure of percutaneous drainage.

Methods

This retrospective study was conducted in a single, tertiary university center from August 2013 to January 2020. Indication was pancreatic collection after acute pancreatitis with PFC requiring EUS-guided drainage after failure of percutaneous drainage.

Results

Twenty-two patients with PFC after acute pancreatitis were included (mean age 64.1 ± 11.3 years) of which 4/22 (18.2%) had pancreatic pseudocyst and 18/22 (81.8%) presented with a walled-off necrosis. Seventy-six interventions were performed among the 22 patients. Lumen-Apposing Metal Stent (LAMS) were used in 5/22 (22.7%) and double pigtail plastic stents in 17/22 (77.3%) of interventions with a median number intervention of 3 per patient (range 1 to 7). Technical success rate was 98.7% (75/76) with an overall clinical success of 81.8% (18/22). Procedure related adverse events rate was 9.1% (2/22) including one bleeding and one pancreatic fistula. Two non-procedure related deaths were observed.

Conclusion

EUS-guided pancreatic collection drainage is clinically effective and safe after clinical/technical failure of radiological percutaneous management.

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Abbreviations

EUS:

Endoscopic ultrasound

EUSD:

EUS-guided drainage

WON:

Walled-off necrosis

LAMS:

Lumen-apposing metal stent

DEN:

Direct endoscopic necrosectomy

PP:

Pancreatic pseudocyst

PFC:

Pancreatic fluid collection

DPPS:

Double pigtails plastic stent

PCD:

Percutaneous drainage

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medical Specialties, University Hospital of Lausanne, CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland

    Sahar Mack, Mariola Marx, Maxime Robert, Elodie Romailler, Sarra Hadjer Oumrani, Nurullah Aslan, Eleni Moschouri, Alain Schoepfer & Sébastien Godat

  2. Division of Gastroenterology, Hôpital Riviera Chablais, HRC, Rennaz, Switzerland

    Domenico Galasso

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  1. Sahar Mack
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Contributions

SM: Study concept and design, definition of intellectual content, literature search, data acquisition, data and statistical analysis, manuscript preparation and editing, DG: definition of intellectual content, clinical studies, manuscript review, MM: definition of intellectual content, clinical studies, manuscript review, MR: manuscript review, ER: manuscript review, SHO: clinical studies, manuscript review, NA: clinical studies, data acquisition, EM: clinical studies, data acquisition, AS: data and statistical analysis, manuscript review, SG: Study concept and design, definition of intellectual content, literature search, clinical studies, manuscript preparation and editing, manuscript review.

Corresponding author

Correspondence to Sébastien Godat.

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Drs Sahar Mack, Domenico Galasso, Mariola Marx, Maxime Robert, Elodie Romailler, Sarra Hadjer Oumrani, Nurullah Aslan, Eleni Moschouri, Prof Alain Schoepfer, and Sebastien Godat have no conflicts of interests or financial ties to disclose.

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Mack, S., Galasso, D., Marx, M. et al. Efficacy and safety of endoscopic ultrasound guided drainage of pseudocysts and walled-off necrosis after failure of percutaneous drainage. Surg Endosc 37, 2626–2632 (2023). https://doi.org/10.1007/s00464-022-09741-6

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