Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections.
OBJECTIVE
To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections.


METHODS
The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively.


RESULTS
Endoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%).


CONCLUSIONS
Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.
Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland. stefan.seewald@gastrozentrum.ch
Stefan
S
Seewald
Tiing Leong
TL
Ang
Hugo
H
Richter
Karl Yu Kim
KY
Teng
Yan
Y
Zhong
Stefan
S
Groth
Salem
S
Omar
Nib
N
Soehendra
D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional