The safety of endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopic control: a single tertiary center experience

Abstract

Background: Endoscopic ultrasonography (EUS) is preferred for guiding drainage of pancreatic fluid collections, with a success rate exceeding 90% when fluoroscopy is used. When fluoroscopy cannot be used, drainage can still be performed, but no data regarding the safety of such a procedure have yet been published.

Aim: To establish the safety of EUS-guided drainage without fluoroscopic control and to identify criteria for the selection of suitable patients.

Methods: The pancreatic fluid collections considered suitable for EUS-guided drainage were >5 cm in diameter, symptomatic, without ductal communication. We attempted EUS-guided drainage of PC prospectively in 24 patients: 9 with abscesses and 15 with pseudocysts.

Results: Drainage was successful in 20 cases (83.3%), with complete resolution after a median 18 months' follow-up. EUS-guided drainage failed in four patients (16.7%): one in the abscess group due to symptomatic pneumoperitoneum and three in the pseudocyst group due to thick wall. Drainage failure was associated with a diameter <6 cm and wall thickness >2 mm and was considered to be due to the sliding of the cystotome on the pseudocyst wall. During follow-up there was one procedure unrelated death (4.1%) and no pancreatic fluid collections relapses.

Conclusions: Fluoroscopic control represents a helpful tool, but it is not always necessary for EUS-guided drainage of pancreatic fluid collections. EUS-guided drainage is possible, efficient and safe without fluoroscopy in selected pancreatic fluid collections with a diameter larger than 6 cm and a thin wall. Collections with a thick wall should be drained under fluoroscopy or referred directly for surgery.