Endoscopic Transmural Drainage of Peripancreatic Fluid Collections: Outcomes and Predictors of Treatment Success in 211 Consecutive Patients

Varadarajulu, Shyam; Bang, Ji Young; Phadnis, Milind A.; Christein, John D.; Wilcox, C. Mel

doi:10.1007/s11605-011-1621-8

Cited by 246 publications

(199 citation statements)

References 30 publications

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“…Sadik et al [48] noted a 94% success rate and 5% complication rate in simple pseudocysts vs 80% success rate and 30% complication rate in infected pseudocysts. Similarly, Varadarajulu et al [49] found a 93.5% success rate and 5% complication rate vs a 63% success rate and 16% complication rate in sterile vs infected pseudocysts. This suggests that while EUS guided drainage is still efficacious, infected pseudocysts are more difficult to drain and associated with a higher complication rate.…”

Section: Percutaneous Drainagementioning

confidence: 89%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

164

154

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Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting. However, with improving pathophysiologic under standing and improving diagnostic tools, it became clear that a more detailed organizational system was required. More specifically, one that distinguished between collections containing fluid alone vs those arising from necrosis and/or containing solid components. As such, a new classification system was developed known as the revised Atlanta criteria [4] . Similar to the original Atlanta Criteria, PFCs are classified as acute (< 4 wk after the pancreatitis episode) or chronic (> 4 wk after the pancreatitis episode). However, in the revised criteria, both acute and chronic collections are further subdivided based on the presence of necrosis within the collection. Acute collections are divided into: acute peripancreatic fluid collections (APFC) and acute necrotic collections (ANC); chronic fluid collections are divided into: pseudocysts or walledoff pancreatic necrosis (WOPN). These new classifications are important because the treatment and management varies depending on the type of collection. ENTERAL FEEDINGThe first step in the management of any PFC is ensuring adequate nutritional support. In mild to moderate acute pancreatitis, oral feeding can be initiated when...

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Section: Percutaneous Drainagementioning

confidence: 89%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

164

154

View full text Add to dashboard Cite

show abstract

“…With expertise PFCs that have failed drainage by other methods and those in unusual locations are also considered for drainage [7,16,23] . Many experts recommend assessment of the main pancreatic duct at the time of PFC drainage with ERCP as uniden- tified pancreatic duct stricture or leak may result in failure of resolution or recurrence of PFC [16,24,25] .…”

Section: Prerequisites For Eus Drainagementioning

confidence: 99%

“…Grimm et al [31] , 1992 (1) Retrospective 100 100 0 Nil Binmoeller et al [21] , 1995 (27) Retrospective 93 78 7 Bleeding (n = 2) Giovannini et al [32] , 2001 (35) Prospective 100 89 3 Pneumoperitoneum (n = 1) Azar et al [33] , 2006 (23) Retrospective 91 82 4 Pneumoperitoneum (n = 1) Antillon et al [19] , 2006 (33) Prospective 94 87 15 Bleeding (n = 4), pneumoperitoneum (n = 1) Krüger et al [34] , [35] , 2006 (46) Prospective 100 93.5 20 Superinfection (n = 4), bleeding (n = 2), pneumoperitoneum (n = 2) stent migration (n = 1) Hookey et al [22] , 2006 (32) Retrospective 96 93 9 Pneumoperitoneum (n = 2), bleeding (n = 1) Lopes et al [36] , 2007 (51) Retrospective 94 84 4 Pneumoperitoneum (n = 1), migration (n = 1) Varadarajulu et al [37] , 2007 (21) Prospective 100 95 0 None Barthet et al [38] , 2008 (28) Prospective 100 89 18 Superinfection (n = 5) Varadarajulu et al [39] , 2008 (24) Randomized controlled trial 100 96 0 Nil…”

Section: Complicationsmentioning

confidence: 99%

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

Puri

Thandassery

Alfadda

et al. 2015

WJGE

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Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.

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“…Clinical success rates of 70% to 87% have been reported in multiple studies, with complication rates of 11% to 34%. 30,[33][34][35] Drainage of more complex collections (acute necrotic collections [ANC], WOPN) can also be achieved surgically, via the percutaneous route, as well as endoscopically. There is controversy in the approach to these complex types of PFCs containing variable amounts of necrotic debris and this is reflected in the most recent consensus guidance from the International Association of Pancreatology (IAP) and the American Pancreatic Association (APA).…”

Section: Eus-guided Transmural Drainage Of Pfcsmentioning

confidence: 99%

“…39 Recent studies have shown that while endoscopic EUS-guided drainage of pseudocysts is highly successful and safe, drainage of necrotic collections is technically more challenging and carries higher risks. 35,40 This suggests that while EUS-guided puncture of a complex PFC-containing solid necrotic material is still technically feasible, some concerns arise as to the effectiveness of draining of the cyst contents through the cyst gastrostomy or cyst-duodenostomy fistulous tract. 41 Some of the inherent risks of the endoscopic approach include the risk of air embolism, endoscopically uncontrollable bleeding and inadequate drainage through multiple plastic stents, as well as early occlusion of the fistulous tract.…”

mentioning

confidence: 99%

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Madácsy

Kaltsidis²

2017

Int J Gastrointest Interv

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A B S T R A C TEndoscopic ultrasound (EUS)-guided management of abdominal fluid collections adjacent to the gastroduodenal lumen is a relatively new concept attracting a lot of interest in recent years. The ability of EUS to identify and drain these collections in the same session accounts for the surge of interest in these novel techniques. On the other hand, the complexity of these interventions and associated serious complications has moderated the enthusiasm of novice endoscopists to some extent and reiterated that focused research and technical innovations are needed to make EUS-guided drainage simpler and safer. Self-expandable metallic stents (SEMS) have emerged in the last decade in the endoscopic management of malignant luminal gastrointestinal strictures. The use of SEMS in the management of benign conditions (biliary, pancreatic, and colonic strictures) is also rapidly expanding. Recently, fully-covered (FC)-SEMS have been successfully used for drainage of peripancreatic and pericholecystic fluid collections. Here we will review the existing data and future directions in the use of FC-SEMS for such drainage procedures. We will also review the literature on novel "purpose-made" prostheses, such as the lumen-apposing metallic stents, which aim to address technical problems arising in EUS-guided drainage procedures when conventional SEMS are used. Further development of these and other similar devices may transform EUS-guided drainage procedures from an esoteric concept to "mainstream", first-line intervention.

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Endoscopic Transmural Drainage of Peripancreatic Fluid Collections: Outcomes and Predictors of Treatment Success in 211 Consecutive Patients

Abstract: Endoscopic therapy is a highly effective technique for the management of patients with non-necrotic peripancreatic fluid collections.

Cited by 246 publications

References 30 publications

Management of pancreatic fluid collections: A comprehensive review of the literature

Management of pancreatic fluid collections: A comprehensive review of the literature

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

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