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. 2017 Oct 21;23(39):7110-7118.
doi: 10.3748/wjg.v23.i39.7110.

Short- and long-term results of endoscopic ultrasound-guided transmural drainage for pancreatic pseudocysts and walled-off necrosis

Yuto Watanabe  1 , Rintaro Mikata  2 , Shin Yasui  1 , Hiroshi Ohyama  1 , Harutoshi Sugiyama  1 , Yuji Sakai  1 , Toshio Tsuyuguchi  1 , Naoya Kato  1
Affiliations

Short- and long-term results of endoscopic ultrasound-guided transmural drainage for pancreatic pseudocysts and walled-off necrosis

Yuto Watanabe et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the short- and long-term results of endoscopic ultrasound-guided transmural drainage (EUS-GTD) for pancreatic fluid collection (PFC) and identify the predictive factors of treatment outcome for walled-off necrosis (WON) managed by EUS-GTD alone.

Methods: We investigated 103 consecutive patients with PFC who underwent EUS-GTD between September 1999 and August 2015. Patients were divided into four groups as follows: WON (n = 40), pancreatic pseudocyst (PPC; n = 11), chronic pseudocyst (n = 33), and others (n = 19). We evaluated the short- and long-term outcomes of the treatment. In cases of WON, multiple logistic regression analyses were performed to identify the predictor variables associated with the treatment success. In addition, PFC recurrence was examined in patients followed up for more than 6 mo and internal stent removal after successful EUS-GTD was confirmed.

Results: In this study, the total technical success rate was 96.1%. The treatment success rate of WON, PPC, chronic pseudocyst, and others was 57.5%, 90.9%, 91.0%, and 89.5%, respectively. Contrast-enhanced computed tomography using the multivariate logistic regression analysis revealed that the treatment success rate of WON was significantly lower in patients with more than 50% pancreatic parenchymal necrosis (OR = 17.0; 95%CI: 1.9-150.7; P = 0.011) and in patients with more than 150 mm of PFC (OR = 27.9; 95%CI: 3.4-227.7; P = 0.002).The recurrence of PFC in the long term was 13.3% (median observation time, 38.8 mo). Mean amylase level in the cavity was significantly higher in the recurrence group than in the no recurrence group (P = 0.02).

Conclusion: The reduction of WON by EUS-GTD alone was associated with the proportion of necrotic tissue and extent of the cavity. The amylase level in the cavity may be a predictive factor for recurrence of PFC.

Keywords: Endoscopic ultrasound-guided transmural drainage; Pancreatic fluid collection; Revised Atlanta Classification; Walled-off necrosis.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts to disclose. All authors disclosed no financial relationships relevant to this publication.

Figures

Figure 1
Figure 1
Kaplan-Meier curve comparing no recurrence rate of amylase in cavity ≥ 63100 with that of amylase in cavity < 63100.
Figure 2
Figure 2
Representative case of walled-off necrosis resolved by endoscopic ultrasound-guided transmural drainage alone. A: Computed tomography of the abdomen (axial image) showing less than 50% pancreatic parenchymal necrosis; B: Pancreatic fluid collection was 135 mm in diameter; C: Rich debris seemed to exist in the cavity as shown by endoscopic ultrasound; D: Endoscopic ultrasound guided transmural drainage was performed and pancreatic fluid collection culture was positive; E: Cavity was reduced at 6 wk after intervention.
See this image and copyright information in PMC

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