title: Forward-viewing versus oblique-viewing echoendoscopes in transluminal drainage of pancreatic fluid collections: a multicenter, randomized, controlled trial.
abstract: BACKGROUND
  EUS-guided drainage of pancreatic fluid collections (PFCs) is commonly performed with oblique-viewing echoendoscopes. However, accessing the PFC under an oblique angle can make drainage difficult. These difficulties might be overcome by using a forward-viewing echoendoscope.
  
  
  OBJECTIVE
  To compare endoscopic PFC drainage with an oblique-viewing versus a forward-viewing echoendoscope with emphasis on ease of endoscopic drainage.
  
  
  METHODS
  Multicenter, randomized, controlled trial.
  
  
  METHODS
  Four tertiary-care referral centers.
  
  
  METHODS
  This study involved 58 patients with PFCs.
  
  
  METHODS
  Patients with PFCs (≥ 6 cm) in whom drainage was indicated were randomized to receive EUS-guided drainage with a forward-viewing echoendoscope or an oblique-viewing echoendoscope. In cases of failed drainage, patients were crossed over to the other study arm.
  
  
  METHODS
  Ease of EUS-guided drainage measured by procedure time. Secondary endpoints included technical success, EUS endoscope preference, clinical success, and adverse events.
  
  
  RESULTS
  Fifty-eight consecutive patients underwent randomization, of whom 52 were available for primary endpoint analysis. All 26 EUS-guided procedures done with the oblique-viewing echoendoscope and 24 of the 26 procedures done with the forward-viewing echoendoscope were technically successful. Mean (± standard deviation) procedure time was 24:55 ± 9:58 minutes in the forward-viewing echoendoscope group and 27:04 ± 9:58 minutes in the oblique-viewing echoendoscope group (P = .44). Median overall procedure ease was graded as equal (easy) in both groups. Drainage-related adverse events occurred in 2 patients (8%) in the forward-viewing echoendoscope group versus none in the oblique-viewing echoendoscope group (P = .56). Overall clinical success was achieved in 82% of patients (95% confidence interval, 69%-91%).
  
  
  CONCLUSIONS
  Derived main outcome parameter and highly specialized endoscopists in tertiary-care referral centers.
  
  
  CONCLUSIONS
  This multicenter, randomized, controlled trial comparing the performance of oblique-viewing echoendoscopes and forward-viewing echoendoscopes in draining PFCs did not show a difference in ease of EUS-guided drainage or procedure safety and efficacy between the forward-viewing echoendoscope and the oblique-viewing echoendoscope. Clinical success was achieved in 82% of patients.
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors: Rogier P
authors: RP
authors: Voermans
authors: Thierry
authors: T
authors: Ponchon
authors: Brigitte
authors: B
authors: Schumacher
authors: Fabien
authors: F
authors: Fumex
authors: Jacques J G H M
authors: JJ
authors: Bergman
authors: Alberto
authors: A
authors: Larghi
authors: Horst
authors: H
authors: Neuhaus
authors: Guido
authors: G
authors: Costamagna
authors: Paul
authors: P
authors: Fockens
mesh_terms: D004322:Drainage / Q000379:methods*; D020776:Endoscopes, Gastrointestinal; D019160:Endosonography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010189:Pancreatic Juice; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D015203:Reproducibility of Results