Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage.
BACKGROUND
Endoscopic transmural drainage is obtained by creating a communication between the intestinal tract and the pancreatic-fluid collection, and then inserting 1 or more stents. Collection recurrence after therapy is noted in 10% to 30% of cases. It is not known whether leaving the stents in position reduces recurrence rates.


OBJECTIVE
To test the hypothesis that patients who have undergone previous successful pancreatic-collection drainage and whose stents are retrieved have higher recurrence rates.


METHODS
Randomized controlled trial.


METHODS
Tertiary referral center.


METHODS
During a period of 27 months, 46 of 77 patients who had undergone endoscopic transmural drainage for pancreatic collections met inclusion or exclusion criteria, and 28 of these patients were randomized.


METHODS
Fifteen patients were assigned to group A, whose stents were left in place, and 13 were assigned to group B, whose stents were removed after collection resolution. The remaining 18 patients, who were not randomized, also had their stents left in place. All 46 patients were similarly followed.


METHODS
Recurrence of the same pancreatic collection that required therapy.


RESULTS
All patients were followed for a median period of 14 months (interquartile range, 8.2-22 months) after treatment. The primary end point was reached in 5 patients in group B (stent retrieval), as opposed to none in group A (P = .013). Moreover, no recurrence was observed in the remaining 18 nonrandomized patients.


CONCLUSIONS
Small sample size.


CONCLUSIONS
In patients who underwent successful transmural drainage of pancreatic collections, stent retrieval was associated with higher recurrence rates.
Arvanitakis
Marianna
M
Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium.
Delhaye
Myriam
M
Bali
Maria Antonietta
MA
Matos
Celso
C
De Maertelaer
Viviane
V
Le Moine
Olivier
O
Devière
Jacques
J
D000328:Adult; D020878:Device Removal / Q000706:statistics & numerical data*; D004322:Drainage; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000517:prevention & control / Q000601:surgery*; D010189:Pancreatic Juice; D011446:Prospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome