Single-Step EUS-Guided Endoscopic Treatment for Sterile Pancreatic Collections: A Single-Center Experience

Abstract

Background and Aims: Endoscopic ultrasound (EUS) is useful for the treatment of sterile pancreatic fluid collections (PFC), either by means of transmural drainage or by complete aspiration. The aim of this study was to evaluate the efficacy and safety of single-step EUS-guided endoscopic approaches for treatment of sterile PFC. Patients and Methods: During a 3-year period, 77 consecutive patients with symptomatic, persistent sterile PFC were evaluated and treated with the linear EUS. We excluded patients with grossly purulent collections, chronic pseudocyst and those whose cytology diagnostic was neoplastic cyst of pancreas. 44 patients received a single 10-Fr plastic straight stent under EUS or fluoroscopic control (group I) and 33 of these underwent a single-step complete aspiration with a 19-gauge needle (group II). Results: The mean size of the sterile PFC was 48 mm in group I and 28 mm in group II (p < 0.001). Overall, endoscopic treatment was successful in 70 (90.9%) patients. The mean volume aspirated was 25 (18–65) ml. The total number of procedures was 50 in group I and 41 punctures in group II. After a mean follow-up of 64 ± 15.6 weeks there were 6 complications (13.6%): 2 recurrences (referred to surgery), 2 developing abscesses (submitted a new EUS-guided endoscopic drainage with success), 1 perforation that died (2.2%), and 1 case of bleeding (sent to surgery) in group I. In group II there were only 6 (18.1%) recurrences (submitted a new EUS-guided aspiration). None of the patients undergoing single-step aspiration developed infections, perforation or hemorrhage. Conclusion: The recurrence of pancreatic pseudocysts after endoscopic treatment was similar, either by means of plastic stents or by complete single-step aspiration.

La kystogastrostomie guidée par échoendoscopie dans le traitement des collections pancréatiques : expérience de l’hôpital militaire de Rabat (Maroc)

“…Un drain nasokystique peut être également mis en place pour une durée limitée en cas de pseudokyste spontanément infecté ou en présence d'une nécrose imparfaitement collectée. Une approche en une seule étape en utilisant uniquement un écho-endoscope est devenue possible avec le développement d'écho-endoscopes linéaires interventionnels à large canal opérateur [19][20][21][22][23]. Les taux de succès global rapportés en utilisant cette méthode, sont supérieurs à 90 % [24], avec un faible taux de récidive de 4 % [25].…”

Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

“…These results appear to compare favorably with previous reports on single-step EUS-guided drainage. 7,8,10 However, inter-study comparison is difficult as the definitions of initial clinical success and recurrence vary among reports. In the current study, EUS-guided aspiration was performed in five patients in whom transmural drainage was failed.…”

“…Other authors have reported that single-step aspiration can be used as an alternative treatment when appropriately indicated. 10 Until now, it is difficult to choose established standard treatment for recurrent pancreatic pseudocysts. We chose observation in 2 recurred patients, and EUS-guided stent reinsertion for the other three patients.…”

“…[7][8][9] Recent pilot studies indicate the efficacy of this approach. 7,8,10 We therefore conducted this study to evaluate the technical feasibility, efficacy, and safety of single-step EUSguided transmural drainage of pancreatic pseudocysts.…”

Papel atual dos métodos de imagem no diagnóstico das neoplasias císticas e sólidas do pâncreas: 2ªparte

“…EE-FNA allows discarding the diagnosis of tumor of the pancreas with a sensitivity of 85-95% and specificity of around 100% for the diagnosis of malignant tumors when performed by an experienced physician 24 . However, it displays a lower negative predictive value (between 20 and 50%) for the diagnosis of malignancy and therefore a negative biopsy does not rule out the existence of cancer 24 ( Figure 12). This tumor is the most commonly found.…”