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

Abstract

AIMTo 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.METHODSWe 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.RESULTSIn 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).CONCLUSIONThe 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.

Comparative efficacy of stents in endoscopic ultrasonography‐guided peripancreatic fluid collection drainage: A systematic review and network meta‐analysis

“…However, based on all data from relevant studies, the risk of recurrence was similar for the LAMS, FCSEMS, and DPPS. According to recent studies, the strongest risk factors for recurrence were identified as PFC occurring from chronic pancreatitis and disconnected pancreatic duct syndrome (DPDS), but not stent type . The likelihood of PFC recurrence with underlying chronic pancreatitis might be attributed to the presence of multifocal main pancreatic duct stricture and multiple pancreatic duct stones and thus an increased risk of intraductal obstruction .…”

“…According to recent studies, the strongest risk factors for recurrence were identified as PFC occurring from chronic pancreatitis and disconnected pancreatic duct syndrome (DPDS), but not stent type . The likelihood of PFC recurrence with underlying chronic pancreatitis might be attributed to the presence of multifocal main pancreatic duct stricture and multiple pancreatic duct stones and thus an increased risk of intraductal obstruction . Furthermore, the DPDS, which is characterized by main pancreatic duct discontinuity in association with a persistent nonhealing pancreatic fistula or PFC, could lead to a persistent leakage of pancreatic juice to PFC .…”

Endoscopic Ultrasound-Guided Drainage and Treatment of Symptomatic Pancreatic Fluid Collection following Acute or Acute-on-Chronic Pancreatitis – A Single Center Case Series

“…Therefore, it would be helpful to identify predictive parameters associated with the need for repeated DEN, since this is the patient group that will probably have the greatest benefit from therapy with LAMS. Factors that were predictive for the need for DEN in previous studies were a larger size of the WON with more necrotic debris [18,19], while the amylase level in the cavity was associated with recurrence of PFC [19]. In our analysis, we could not confirm an association between the size of the PFC (as measured by EUS) and treatment time or number of follow-up endoscopic sessions.…”

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

“…We speculated this was related to the higher mean proportion of solid debris roughly calculated by CT in infection group (32%) than non-infection group (15%). Watanabe et al also proposed that patients with WON with a high proportion of necrotic tissue had lower treatment success rate 36 . Although we found no statistical difference in postoperative infection between WON and PPC, the summary of RR on the postoperative infection may indicate that the potential risk in WON (9%) was 1.57 times (95%CI: 0.73-3.39) higher than PPC (2%).…”