Endoscopic drainage and endoscopic necrosectomy in the management of symptomatic pancreatic collections.
OBJECTIVE
To evaluate the role of endoscopic drainage and endoscopic necrosectomy in the management of symptomatic pancreatic fluid collection.


METHODS
The clinical data of patients with symptomatic pancreatic fluid collection referred for endoscopic drainage were captured prospectively and analyzed. Pancreatic duct disruption was treated with stenting. Endosonography-guided transmural drainage and endoscopic necrosectomy were performed when indicated.


RESULTS
Fifteen consecutive patients (mean age 53.7 years; range 23-82 years) underwent endoscopic management of pancreatic fluid collections (pseudocysts: six; abscesses: six; infected walled-off necrosis: three). Pancreatic duct fistulas were present in 13 patients. The drainage techniques used were: (i) transpapillary drainage; five; (ii) transmural drainage; two (these two patients had no pancreatic duct fistulas); and (iii) combined transpapillary and transmural drainage; eight. An additional transgastric endoscopic necrosectomy was performed in five patients. The endoscopic treatment was successful in all cases. The only complication was asymptomatic pneumo-peritoneum that occurred in one patient. Combined transpapillary and transmural drainage led to the faster resolution of the fluid collection compared to transpapillary drainage (75.6 vs 147 days, P = 0.03). No recurrence occurred over a mean follow up of 486 days.


CONCLUSIONS
Endoscopic drainage and endoscopic necrosectomy are safe and effective techniques for the treatment of symptomatic pancreatic fluid collection.
Ang
Tiing Leong
TL
Division of Gastroenterology, Changi General Hospital, Singapore. tiing_leong_ang@cgh.com.sg
Teo
Eng Kiong
EK
Fock
Kwong Ming
KM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010183:Pancreatic Ducts / Q000601:surgery; D010185:Pancreatic Fistula / Q000601:surgery; D013396:Suction / Q000379:methods; D055815:Young Adult