title: The safety of endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopic control: a single tertiary center experience.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS) is preferred for guiding drainage of pancreatic fluid collections, with a success rate exceeding 90% when fluoroscopy is used. When fluoroscopy cannot be used, drainage can still be performed, but no data regarding the safety of such a procedure have yet been published.
  
  
  OBJECTIVE
  To establish the safety of EUS-guided drainage without fluoroscopic control and to identify criteria for the selection of suitable patients.
  
  
  METHODS
  The pancreatic fluid collections considered suitable for EUS-guided drainage were >5 cm in diameter, symptomatic, without ductal communication. We attempted EUS-guided drainage of PC prospectively in 24 patients: 9 with abscesses and 15 with pseudocysts.
  
  
  RESULTS
  Drainage was successful in 20 cases (83.3%), with complete resolution after a median 18 months' follow-up. EUS-guided drainage failed in four patients (16.7%): one in the abscess group due to symptomatic pneumoperitoneum and three in the pseudocyst group due to thick wall. Drainage failure was associated with a diameter <6 cm and wall thickness >2 mm and was considered to be due to the sliding of the cystotome on the pseudocyst wall. During follow-up there was one procedure unrelated death (4.1%) and no pancreatic fluid collections relapses.
  
  
  CONCLUSIONS
  Fluoroscopic control represents a helpful tool, but it is not always necessary for EUS-guided drainage of pancreatic fluid collections. EUS-guided drainage is possible, efficient and safe without fluoroscopy in selected pancreatic fluid collections with a diameter larger than 6 cm and a thin wall. Collections with a thick wall should be drained under fluoroscopy or referred directly for surgery.
authors: Third Medical Clinic,University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania. andradaseicean@yahoo.com
authors: Andrada
authors: A
authors: Seicean
authors: Roxana
authors: R
authors: Stan-Iuga
authors: Radu
authors: R
authors: Badea
authors: Marcel
authors: M
authors: Tantau
authors: Teodora
authors: T
authors: Mocan
authors: Radu
authors: R
authors: Seicean
authors: Cornel
authors: C
authors: Iancu
authors: Oliviu
authors: O
authors: Pascu
mesh_terms: D000038:Abscess / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000009:adverse effects*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000628:therapy*; D010192:Pancreatic Pseudocyst / Q000628:therapy*