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

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.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.

Endotherapy for pancreatic necrosis: An update

“…The endotherapy cohort required fewer interventions, had lower rates of residual collections, and the need for surgical intervention. The procedural complications were higher in the endotherapy cohort compared to the PCD group (10 vs 1%) . In a systematic review of 11 studies, including one RCT, aiming to assess the role of PCD as a primary treatment for acute necrotizing pancreatitis, 55.7% patients improved without additional surgical necrosectomy.…”

“…The procedural complications were higher in the endotherapy cohort compared to the PCD group (10 vs 1%). 54 In a systematic review of 11 studies, including one RCT, aiming to assess the role of PCD as a primary treatment for acute necrotizing pancreatitis, 55.7% patients improved without additional surgical necrosectomy. The overall complication rate was 20%, and the most common complications 61 In a review analysis, the MARPNs were compared with EN.…”

Review of management options for pancreatic pseudocysts

“…When compared with ED, percutaneous intervention seems to have similar percentages of success rates and clinical success, but PD has worse results in terms of hospital stay and rates of reintervention (9.8% vs. 42%, P=0.001) (17). In a recent study, ED was compared with PD in the treatment of pancreatic fluid collections and although ED was associated with higher procedural adverse effects, PD was inferior in terms of residual collections (20% vs. 53%), need for reintervention and need for SD (4% vs. 6%) (18). More recently, novel hybrid and endoscopic techniques which combine pseudocyst irrigation and along with pancreatic necrosectomy have been described and performed in specialized centers (19).…”

Role of Image-Guided Percutaneous Drainage in Pancreatic Collections

“…Although percutaneous drainage is more accessible and convenient compared with endoscopic approach, some studies have demonstrated that endoscopic drainage is associated with shorter hospital stay, fewer interventions, and higher success rate compared with percutaneous drainage. [39][40][41][42] However, complication rates are reported to be higher with endoscopic drainage (36%), whereas the only major complication in percutaneous method is fistula formation, which occurs in only 8% of patients. 39 Gluck and colleagues 43 conducted a study investigating the efficacy of combined endoscopic and percutaneous drai-nage in the treatment of pancreatic necrosis.…”

“…[39][40][41][42] However, complication rates are reported to be higher with endoscopic drainage (36%), whereas the only major complication in percutaneous method is fistula formation, which occurs in only 8% of patients. 39 Gluck and colleagues 43 conducted a study investigating the efficacy of combined endoscopic and percutaneous drai-nage in the treatment of pancreatic necrosis. In this study, patients were transferred for endoscopic drainage shortly after percutaneous aspiration of collections performed in their center.…”