title: Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study.
abstract: OBJECTIVE
  The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution.
  
  
  METHODS
  This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression.
  
  
  RESULTS
  A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P = .0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P = .23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P = .37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P = .61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P = .79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P = .03).
  
  
  CONCLUSIONS
  TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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authors.lastname: Yang
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Sunil
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authors.lastname: Amin
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Susana
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authors.lastname: Gonzalez
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Daniel
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authors.lastname: Mullady
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Stephen
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authors.lastname: Hasak
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Srinivas
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authors.lastname: Gaddam
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Mark A
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authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mohamad
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authors.lastname: El Zein
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Gaspar
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Dushant S
authors.initials: DS
authors.lastname: Uppal
authors.affiliation: Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA.
authors.forename: Satish
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authors.affiliation: Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA.
authors.forename: Samir
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authors.lastname: Kapadia
authors.affiliation: Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Buscaglia
authors.affiliation: Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Bucobo
authors.affiliation: Division of Gastroenterology, University of Florida, Gainesville, Florida, USA.
authors.forename: Alex
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authors.lastname: Schlachterman
authors.affiliation: Division of Gastroenterology, University of Florida, Gainesville, Florida, USA.
authors.forename: Mihir S
authors.initials: MS
authors.lastname: Wagh
authors.affiliation: Division of Gastroenterology, University of Florida, Gainesville, Florida, USA.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Draganov
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Tyler
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authors.lastname: Stevens
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: Harshit S
authors.initials: HS
authors.lastname: Khara
authors.affiliation: Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Huseini
authors.affiliation: Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Diehl
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Law
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Srinadh
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authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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authors.initials: PS
authors.lastname: Yachimski
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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authors.lastname: DaVee
authors.affiliation: Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Anoop
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authors.lastname: Prabhu
authors.affiliation: Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Lapp
authors.affiliation: Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.affiliation: Division of Digestive Diseases, University of California at Los Angeles School of Medicine, Los Angeles, California, USA.
authors.forename: Rabindra R
authors.initials: RR
authors.lastname: Watson
authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, New York, USA.
authors.forename: Adam J
authors.initials: AJ
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authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, New York, USA.
authors.forename: Natasha
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authors.affiliation: Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA.
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authors.initials: WJ
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authors.affiliation: Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA.
authors.forename: Petros
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authors.lastname: Benias
authors.affiliation: Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Carr-Locke
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects