LONG-TERM RESULTS AFTER ENDOSCOPIC DRAINAGE AND NECROSECTOMY OF SYMPTOMATIC PANCREATIC FLUID COLLECTIONS

• Published in: Digestive endoscopy 2012-01, Vol.24 (1), p.36-41
• Main Authors: SEEWALD, STEFAN, ANG, TIING LEONG, RICHTER, HUGO, TENG, KARL YU KIM, ZHONG, YAN, GROTH, STEFAN, OMAR, SALEM, SOEHENDRA, NIB
• Format: Article
• Language: English
• Subjects: abscess; Abscess - diagnostic imaging; Abscess - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Child; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; drainage; endoscopy; Endosonography; Female; Humans; Male; Middle Aged; necrosis; Pancreatic Diseases - diagnostic imaging; Pancreatic Diseases - surgery; pancreatic fluid collection; Pancreatic Pseudocyst - diagnostic imaging; Pancreatic Pseudocyst - surgery; Pancreatitis, Acute Necrotizing - diagnostic imaging; Pancreatitis, Acute Necrotizing - surgery; pseudocyst; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/j.1443-1661.2011.01162.x

Aims:  To determine the immediate and long‐term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections. Methods:  The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3–20; pseudocysts: 24/80, abscess: 20/80, infected walled‐off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively. Results:  Endoscopic drainage techniques included endoscopic ultrasound (EUS)‐guided aspiration (2/80), EUS‐guided transenteric drainage (70/80) and non‐EUS‐guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long‐term success of endoscopic treatment was 58/80 (72.5%). Conclusions:  Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long‐term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.