Definitive treatment of pancreatic abscess by endoscopic transmural drainage.
BACKGROUND
Experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of pancreatic abscess. The aim of this study was to assess the feasibility, safety, and effectiveness of endoscopic transmural drainage for the treatment of pancreatic abscesses compressing the gut lumen.


METHODS
In 9 patients, a total of 11 pancreatic abscesses compressing the stomach, duodenum, or both organs were drained endoscopically by means of endoscopic fistulization followed by saline solution irrigation and subsequent stent(s) placement. Complete resolution of the pancreatic abscess was defined as the absence of symptoms and no residual collection on follow-up CT.


METHODS
Endoscopic transmural drainage was technically successful in all cases. Ten abscess cavities (91%) resolved completely after stent placement for a mean duration of 32 days. In 2 patients, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. Bleeding occurred in 1 case (11%) but there was no mortality. The relapse rate was 13% over a mean follow-up of 18 months.


CONCLUSIONS
Endoscopic transmural drainage is an effective therapy with minimal morbidity for pancreatic abscess compressing the gut lumen and is a valuable alternative to surgical drainage.
Park
Jong Jae
JJ
Department of Internal Medicine, Gil Medical Center, Gachon Medical School, Namdong-Gu, Inchon City, South Korea.
Kim
Sun Suk
SS
Koo
Yang Seoh
YS
Choi
Duck Joo
DJ
Park
Hyun Chul
HC
Kim
Ju Hyun
JH
Kim
Jae Sun
JS
Hyun
Jin Hai
JH
D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D002648:Child; D004322:Drainage; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000628:therapy*; D004384:Duodenoscopy; D006801:Humans; D007223:Infant; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents; D014057:Tomography, X-Ray Computed