Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm
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Background/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomaticpancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs andreport on its effcacy and safety. Methods: Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs wereclassified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm. Results: A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwopatients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patientsachieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patientswith enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was fivetimes more likely to achieve resolution within 90 days (p=0.0069). Conclusions: A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PDstenting, and early enteral feeding is adopted.
Abstract
Background/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomaticpancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs andreport on its effcacy and safety. Methods: Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs wereclassified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm. Results: A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwopatients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patientsachieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patientswith enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was fivetimes more likely to achieve resolution within 90 days (p=0.0069). Conclusions: A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PDstenting, and early enteral feeding is adopted.
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