Outcome following endoscopic transmural drainage of pancreatic fluid collections in outpatients.
OBJECTIVE
To evaluate the performance of endoscopic transmural drainage of pancreatic fluid collections (PFCs) in outpatients.


METHODS
We retrospectively reviewed 19 consecutive outpatient cases in 18 patients who underwent attempted endoscopic transmural drainage of PFCs by a single endoscopist at the Mayo Clinic in Rochester, MN, over a 5-year period (October 1998 to October 2003). All drainages were performed without EUS-guided entry, using an aspiration needle and no cautery. Two 10-Fr stents were placed after dilation of the entry site.


RESULTS
The study group consisted of 12 men and 6 women (median age, 48 years; range, 28-79 years), with 14 cases of pseudocysts and 5 cases of pancreatic necrosis. Transmural drainage approaches included 13 transgastric, 5 transduodenal, and 1 combined transgastric/transpapillary. Drainage was established in 16 of 19 (84%) cases. Hospitalization was noted in 6 of 19 (32%) cases, with median hospitalization duration of 1.5 days (range, 1-19 days). Three patients were hospitalized for overnight observation only. In all instances, the decision to hospitalize was made while the patient was still in recovery. No deaths occurred. Follow-up imaging was available in 15 of 16 (94%) cases in which drainage was established, demonstrating PFC resolution in all 15.


CONCLUSIONS
Endoscopic transmural drainage of PFCs can be performed safely and effectively in selected outpatients. It is our opinion that outpatient drainage of PFCs be considered only by experienced therapeutic endoscopists with readily available inpatient facilities. Future studies should seek to identify predictors of hospitalization and address cost-effectiveness.
Department of Medicine, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
Christopher M
CM
Gibbs
Todd H
TH
Baron
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020420:Cyst Fluid; D004322:Drainage / Q000379:methods*; D004384:Duodenoscopy; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome