Efficacy and safety of endoscopic drainage of peripancreatic fluid collections: a retrospective multicenter European study

Gkolfakis, Paraskevas; Petrone, Maria Chiara; Tadić, Mario; Tziatzios, Georgios; Karoumpalis, Ioannis; Crinò, Stefano Francesco; Facciorusso, Antonio; Hritz, István; Kypraios, Dimitrios; Sioulas, Athanasios D.; Scotiniotis, Ilias; Vezakis, Αntonios; Keczer, Bánk; Koukoulioti, Eleni; Muscatiello, Nicola; Triantafyllou, Konstantinos; Polydorou, Andreas; Grgurević, Ivica; Arcidiacono, Paolo Giorgio; Papanikolaou, Ioannis S.

doi:10.20524/aog.2022.0753

Cited by 6 publications

(6 citation statements)

References 28 publications

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“…The endoscopic step-up approach achieves more successful resolution (88% vs 45%; p=0.03) and shorter hospital stays (15 days vs. 38 days p=0.448) compared with standard endoscopic drainage alone or percutaneous drainage alone [19,26]. A previous study showed that LAM stents were superior to plastic stents in terms of overall treatment efficacy and number of endoscopy sessions (2.2 vs 3.6; p=0.04) [25,20,27]. The larger lumen diameter stents allow adequate drainage and prevent occlusion and subsequent infection, which were strengths of LAM over DPPS.…”

Section: Discussionmentioning

confidence: 97%

“…Clinical success was considered a successful ETD and DEN, defined as a decrease in the size of the WON to < 3 cm on cross-sectional imaging, with resolution of symptoms within 6-months of follow-up. 20 Endoscopic transmural drainage EUS was performed using a linear array echoendoscope (GF-UCT/P-180 series; Olympus Medical System, Corp., Tokyo, Japan) and ultrasound machine (model SSD alpha 10; Aloka, Tokyo, Japan). Before the procedure, the indications for drainage and abdominal cross-sectional imaging were reviewed, and WON was identified by EUS.…”

Section: Study Definitionsmentioning

confidence: 99%

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Clinical Outcomes of the Endoscopic Step-Up Approach With or Without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis

Pattarapuntakul¹,

Charoenrit²,

Wong³

et al. 2023

Preprint

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Background and objectives: Symptomatic walled-off pancreatic necrosis is a serious local complication of acute necrotising pancreatitis. The endoscopic step-up approach is the standard treatment for symptomatic walled-off pancreatic necrosis; however, adjunctive radiologic percu-taneous drainage for this condition is controversial. This study compared the clinical and radio-logic resolution of walled-off pancreatic necrosis achieved with the endoscopic step-up approach with or without radiology-guided percutaneous drainage. Material and Methods: This retrospective, single-center cohort study enrolled patients with symp-tomatic walled-off pancreatic necrosis who underwent endoscopic transmural drainage (ETD) followed by directed endoscopic necrosectomy (DEN) with or without radiology-guided drainage. A total of 34 patients (endoscopic approach, n=22; combined modality approach, n=12) underwent the endoscopic step-up approach (ETD followed by DEN). Baseline characteristics, clinical success, and resolution of necrosis were compared between groups. Results: All patients achieved symptom resolution from walled-off pancreatic necrosis. The mean patient age was 58.4 years, and 21 (61.8%) were men. After treatment with the endoscopic approach and combined modality approach, clinical success was achieved in 90.9% of patients within 11.5 days, and 66.7% of patients within 16.5 days, respectively. Both the total hospital stay (55 days vs 71 days; p=0.071) and time to complete radiologic resolution were shorter (93 days vs 124 days; p=0.23) in the endoscopic approach group. Conclusion: The endoscopic step-up approach resulted in the clinical resolution of symptomatic walled-off pancreatic necrosis comparable to that of the combined modality drainage. However, the endoscopic approach alone allows higher clinical success, early clinical and radiologic resolution, and a shorter hospital stay.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Study Definitionsmentioning

confidence: 99%

Clinical Outcomes of the Endoscopic Step-Up Approach With or Without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis

Pattarapuntakul¹,

Charoenrit²,

Wong³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…For the ETD procedure, a LAMS (NAGI stent) was used in approximately 80% of our cohort. A previous study showed that LAM stents were superior to plastic stents in terms of overall treatment efficacy and number of endoscopy sessions (2.2 vs. 3.6; p = 0.04) [ 16 , 21 , 23 ]. The larger lumen diameter stents allow for adequate drainage and prevent occlusion and subsequent infection, which were strengths of LAM over DPPS.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical resolution was defined as improvement in the sign and symptoms of systemic inflammatory response syndrome (SIRS), sepsis, abdominal pain, and able to resume oral diet after the intervention. Clinical success was considered as successful ETD and DEN, defined as a decrease in the size of WON to <3 cm on cross-sectional abdominal imaging, with resolution of symptoms within 6 months of follow-up [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis

et al. 2023

View full text Add to dashboard Cite

Background and objectives: Symptomatic walled-off pancreatic necrosis is a serious local complication of acute necrotising pancreatitis. The endoscopic step-up approach is the standard treatment for symptomatic walled-off pancreatic necrosis; however, adjunctive radiologic percutaneous drainage for this condition is controversial. This study compared the clinical and radiologic resolution of walled-off pancreatic necrosis achieved with the endoscopic step-up approach with or without radiology-guided percutaneous drainage. Material and Methods: This retrospective, single-centre cohort study enrolled patients with symptomatic walled-off pancreatic necrosis who underwent endoscopic transmural drainage (ETD) followed by directed endoscopic necrosectomy (DEN) with or without radiology-guided drainage. A total of 34 patients (endoscopic approach, n = 22; combined modality approach, n = 12) underwent the endoscopic step-up approach (ETD followed by DEN). Baseline characteristics, clinical success, and resolution of necrosis were compared between groups. Results: All patients achieved symptom resolution from walled-off pancreatic necrosis. The mean patient age was 58.4 years, and 21 (61.8%) were men. Following treatment with the endoscopic approach and combined modality approach, clinical success was achieved in 90.9% of patients within 11.5 days, and 66.7% of patients within 16.5 days, respectively. Both length of hospital stay (55 days vs. 71 days; p = 0.071) and time to complete radiologic resolution were shorter (93 days vs. 124 days; p = 0.23) in the endoscopic approach group. Conclusion: Both the endoscopic step-up approach and the CMD approach resulted in a favourably high clinical resolution rates in patients with symptomatic WON. However, clinical success rates seemed to be higher, and the length of hospital stay tended to be shorter in the endoscopic approach than in the CMD approach, as well as the significantly shorter necrosectomy time in each procedure was observed. Of note, these findings might be from some inherited differences in baseline characteristics of the patients between the two groups, and a randomized controlled trial with a larger sample size to verify these results is warranted.

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“…Usually, LAMS-associated fistulas are closed in their natural course 1 2 3 . We encountered a rare case in which a long-term remaining fistula resulted in WON relapse, which was successfully treated by closing the fistula using a new endoscopic suturing device.…”

Section: Figmentioning

confidence: 99%

Rare complications related to lumen-apposing metal stent placement, successfully treated by endoscopic hand-suturing device.

et al. 2023

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Efficacy and safety of endoscopic drainage of peripancreatic fluid collections: a retrospective multicenter European study

Cited by 6 publications

References 28 publications

Clinical Outcomes of the Endoscopic Step-Up Approach With or Without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis

Clinical Outcomes of the Endoscopic Step-Up Approach With or Without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis

Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis

Rare complications related to lumen-apposing metal stent placement, successfully treated by endoscopic hand-suturing device.

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