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.MethodsBetween 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.ResultsIn 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.ConclusionCompared 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.
ObjectivesPainful chronic pancreatitis (CP) is often associated with main duct obstruction due to stones.Approaches to management are challenging, including surgery, extracorporeal shock wave lithotripsy, or endoscopic approaches. Here we report our experience of pancreatoscopy + electrohydraulic lithotripsy (EHL) for pancreatic duct (PD) stones using SpyGlass.
MethodsWe retrospectively audited the use of SpyGlass (Legacy & DS™) + EHL. Indication, procedural details, and clinical outcome were assessed.
Results118 SpyGlass + EHL procedures for stones were performed, of which 8 (7%) for pancreatic stones, in 6 patients (3 female, mean age 45 years ±7 years). All patients had painful CP, with radiological evidence of a dilated PD, and main duct stone disease. Surgical options had been considered in all cases. Stone fragmentation and PD decompression was achieved in 83% (n=5) without complications. Two patients required two EHL procedures to achieve clearance. One patient failed clearance, pancreatoscopy revealed a stone in the adjacent parenchyme and not in PD. All patients with successful EHL had pain relief/marked improvement at clinical review (mean follow-up 2.7 ±1.1 years).
ConclusionPancreatoscopy + EHL may have a valuable role in treating obstructing pancreatic ductal stones, possibly avoiding the need for surgery in some patients.
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