Endoscopic transpapillary drainage of pancreatic abscess: technique and results.
BACKGROUND
Pancreatic abscess is one of the serious complications of acute pancreatitis. Traditionally, pancreatic abscess has been treated by operative drainage. Based on experience with endoscopic transpapillary drainage of pseudocysts, a similar technique was used in patients with pancreatic abscess.


METHODS
Patients were evaluated by endoscopic retrograde cholangiopancreatography. In those with pancreatic abscess communicating with the main pancreatic duct, pancreatic sphincterotomy, saline irrigation of the abscess cavity, and catheter dilation followed by 10F pancreatic stent placement were done. Instillation of gentamicin and nasopancreatic catheter drainage were used in difficult cases.


RESULTS
Of 22 patients with pancreatic abscess, 11 underwent endoscopic transpapillary drainage with technical success in 10 patients (90%); 8 patients (74%) had resolution of pancreatic abscess, clinically and radiographically. Intracavitary instillation of gentamicin and nasopancreatic catheter drainage were used in 2 patients. Two patients in whom endoscopic transpapillary drainage failed underwent operative drainage with a favorable outcome, and the one patient in whom endoscopic treatment was technically unsuccessful underwent successful percutaneous drainage. One patient had mild pancreatitis.


CONCLUSIONS
Endoscopic transpapillary drainage is an effective nonoperative therapy for selected cases of pancreatic abscess and is associated with minimal morbidity and no mortality.
Venu
R P
RP
University of Illinois at Chicago Medical Center, Chicago, Illinois 60612-7323, USA.
Brown
R D
RD
Marrero
J A
JA
Pastika
B J
BJ
Frakes
J T
JT
D018784:Abdominal Abscess / Q000209:etiology / Q000628:therapy*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000628:therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy; D013290:Streptococcal Infections / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents