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. 2016 Sep;30(9):3730-40.
doi: 10.1007/s00464-015-4668-x. Epub 2015 Dec 16.

Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre

Margaret G Keane  1 , Shun Fung Sze  2 , Natascha Cieplik  2 , Sam Murray  3 , Gavin J Johnson  3 , George J Webster  3 , Douglas Thorburn  2 , Stephen P Pereira  4
Affiliations

Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre

Margaret G Keane et al. Surg Endosc. 2016 Sep.

Abstract

Introduction: Endoscopic transmural drainage (ED) or percutaneous drainage (PD) has mostly replaced surgery for the initial management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare outcomes for patients undergoing ED or PD of symptomatic PFCs.

Methods: Between January 2000 and December 2013, all patients who required PD or ED of a PFC were included. Rates of treatment success, length of hospital stay, adverse events, re-interventions and length of follow-up were recorded retrospectively in all cases.

Results: In total, 164 patients were included in the study; 109 patients underwent ED; and 55 had PD alone. During the 14-year study period, the incidence of ED increased and PD fell. In the 109 patients who were managed by ED, treatment success was considerably higher than in those managed by PD (70 vs. 31 %). Rates of procedural adverse events were higher in the ED cohort compared to the PD group (10 vs. 1 %), but patients managed by ED required fewer interventions (median of 1.8 vs. 3.3) had lower rates of residual collections (21 vs. 67 %) and need for surgical intervention (4 vs. 11 %). In the ED group, treatment success was similar for walled-off pancreatic necrosis (WOPN) and pseudocysts (67 vs. 72 %, P = 0.77). There were no procedure-related deaths.

Conclusion: Compared with PD, ED of symptomatic PFCs was associated with higher rates of treatment success, lower rates of re-intervention, including surgery and shorter lengths of hospital stay. Outcomes in WOPN were comparable to those in patients with pseudocysts.

Keywords: Acute pancreatitis; Chronic pancreatitis; Endoscopic drainage; Endoscopic ultrasound; Pseudocyst; Walled-off pancreatic necrosis.

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Figures

Fig. 1
Fig. 1
Flow chart demonstrating patient selection and proportion of patients with pseudocysts and WOPN in each cohort. WOPN walled-off pancreatic necrosis, ERCP + TPD endoscopic retrograde cholangiopancreatography + transpapillary drainage, EUS-FNA endoscopic ultrasound and fine needle aspiration
Fig. 2
Fig. 2
Number of patients undergoing drainage of a pancreatic fluid collection annually during the study period
See this image and copyright information in PMC

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