title: Clinical outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts: a large multicenter study.
abstract: Background and study aimsData on clinical outcomes of endoscopic drainage of debris-free pseudocysts (PDF) versus pseudocysts containing solid debris (PSD) are very limited. The aims of this study were to compare treatment outcomes between patients with PDF vs. PSD undergoing endoscopic ultrasound (EUS)-guided drainage via transmural stents.Patients and methodsRetrospective review of 142 consecutive patients with pseudocysts who underwent EUS-guided transmural drainage (TM) from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM technical success, treatment outcomes (symptomatic and radiologic resolution), need for endoscopic re-intervention at follow-up, and adverse events (AEs).ResultsTM was performed in 90 patients with PDF and 52 with PSD. Technical success: PDF 87 (96.7 %) vs. PSD 51 (98.1 %). There was no difference in the rates for endoscopic re-intervention (5.5 % in PDF vs. 11.5 % in PSD;P =0.33) or AEs (12.2 % in PDF vs. 19.2 % in PSD;P= 0.33). Median long-term follow-up after stent removal was 297 days (interquartile range [IQR]: 59 - 424 days) for PDF and 326 days (IQR: 180 - 448 days) for PSD (P= 0.88). There was a higher rate of short-term radiologic resolution of PDF (45; 66.2 %) vs. PSD (21; 51.2 %) (OR = 0.30; 95 % CI: 0.13 - 0.72;P= 0.009). There was no difference in long-term symptomatic resolution (PDF: 70.4 % vs. PSD: 66.7 %;P= 0.72) or radiologic resolution (PDF: 68.9 % vs. PSD: 78.6 %;P= 0.72)ConclusionsThere was no difference in need for endoscopic re-intervention, AEs or long-term treatment outcomes in patients with PDF vs. PSD undergoing EUS-guided drainage with transmural stents. Based on these results, the presence of solid debris in pancreatic fluid collections does not appear to be associated with a poorer outcome.
authors.affiliation: Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United Sates.
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authors.lastname: Yang
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
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, United States.
authors.forename: Susana
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authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, United States.
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authors.affiliation: Division of Gastroenterology, University of Colorado, Aurora, Colorado, United States.
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authors.affiliation: Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, United States.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States.
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authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, United States.
authors.forename: Andrew Y
authors.initials: AY
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authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Satish
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authors.lastname: Nagula
authors.affiliation: Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, United States.
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, United States.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Bucobo
authors.affiliation: Division of Gastroenterology, University of Colorado, Aurora, Colorado, United States.
authors.forename: Mihir S
authors.initials: MS
authors.lastname: Wagh
authors.affiliation: Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United Sates.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Draganov
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Tyler
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authors.lastname: Stevens
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States.
authors.forename: Harshit S
authors.initials: HS
authors.lastname: Khara
authors.affiliation: Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States.
authors.forename: David L
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authors.lastname: Diehl
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
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, United States.
authors.forename: Srinadh
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authors.lastname: Komanduri
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Yachimski
authors.affiliation: Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, United States.
authors.forename: Anoop
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authors.lastname: Prabhu
authors.affiliation: Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, United States.
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, United States.
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, United States.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Goodman
authors.affiliation: Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, United States.
authors.forename: Petros
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authors.lastname: Benias
authors.affiliation: Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, United States.
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, United States.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiMaio