title: Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre.
abstract: Endoscopic transmural drainage (ED) or percutaneous drainage (PD) has mostly replaced surgery for the initial management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare outcomes for patients undergoing ED or PD of symptomatic PFCs.
  
  
  
  Between January 2000 and December 2013, all patients who required PD or ED of a PFC were included. Rates of treatment success, length of hospital stay, adverse events, re-interventions and length of follow-up were recorded retrospectively in all cases.
  
  
  
  In total, 164 patients were included in the study; 109 patients underwent ED; and 55 had PD alone. During the 14-year study period, the incidence of ED increased and PD fell. In the 109 patients who were managed by ED, treatment success was considerably higher than in those managed by PD (70 vs. 31 %). Rates of procedural adverse events were higher in the ED cohort compared to the PD group (10 vs. 1 %), but patients managed by ED required fewer interventions (median of 1.8 vs. 3.3) had lower rates of residual collections (21 vs. 67 %) and need for surgical intervention (4 vs. 11 %). In the ED group, treatment success was similar for walled-off pancreatic necrosis (WOPN) and pseudocysts (67 vs. 72 %, P = 0.77). There were no procedure-related deaths.
  
  
  
  Compared with PD, ED of symptomatic PFCs was associated with higher rates of treatment success, lower rates of re-intervention, including surgery and shorter lengths of hospital stay. Outcomes in WOPN were comparable to those in patients with pseudocysts.
authors.affiliation: Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK. geri.keane.09@ucl.ac.uk.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Keane
authors.affiliation: Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK.
authors.forename: Shun Fung
authors.initials: SF
authors.lastname: Sze
authors.affiliation: Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK.
authors.forename: Natascha
authors.initials: N
authors.lastname: Cieplik
authors.affiliation: Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Murray
authors.affiliation: Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Johnson
authors.affiliation: Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK.
authors.forename: George J
authors.initials: GJ
authors.lastname: Webster
authors.affiliation: Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: Thorburn
authors.affiliation: Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK. stephen.pereira@ucl.ac.uk.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004322:Drainage; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008131:London; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute pancreatitis; Chronic pancreatitis; Endoscopic drainage; Endoscopic ultrasound; Pseudocyst; Walled-off pancreatic necrosis