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Endoscopy 2009; 41(10): 842-848
DOI: 10.1055/s-0029-1215133
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial

D.  H.  Park1 , S.  S.  Lee1 , S.-H.  Moon1 , S.  Y.  Choi1 , S.  W.  Jung1 , D.  W.  Seo1 , S.  K.  Lee1 , M.-H.  Kim1
  • 1Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
Further Information

Publication History

submitted 27 June 2009

accepted after revision 21 July 2009

Publication Date:
01 October 2009 (online)

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Commentaire de travail de D. H. Park et al., pp. 842Endoscopy 2009; 41(10): 921-921
DOI: 10.1055/s-0032-1306750

Background and study aims: Although endoscopic ultrasound (EUS)-guided transmural drainage (EUD) is preferred over conventional transmural drainage (CTD) of pancreatic pseudocysts by endoscopy in many centers, its superiority with respect to technical success and clinical outcome has not yet been demonstrated in a prospective randomized trial. We conducted this prospective randomized trial to compare the technical success and clinical outcomes of EUD and CTD in treating pancreatic pseudocysts.

Patients and methods: A total of 60 consecutive patients with pancreatic pseudocysts were randomly divided into two groups to undergo either EUD (n = 31) or CTD (n = 29) of pancreatic pseudocysts. The technical success rate, complications, and short-term and long-term results were prospectively evaluated.

Results: The rate of technical success of the drainage was higher for EUD (94 %, 29/31) than for CTD (72 %, 21/29; P = 0.039) in intention-to-treat analysis. In cases where CTD failed (n = 8), because the pseudocysts were nonbulging, a crossover was made to EUD, which was successfully performed in all these patients. Complications occurred in 7 % of the EUD and 10 % of the CTD group (P = 0.67). During short-term follow-up, pseudocyst resolution was achieved in 97 % (28/29) in the EUD group and in 91 % (19/21) in the CTD group (P = 0.565). Long-term results analyzed on a per-protocol basis showed no significant difference in clinical outcomes between EUD (89 %, 33/37) and CTD (86 %, 18/21, P = 0.696).

Conclusions: We found that EUD and CTD can both be considered first-line methods of endoscopic transmural drainage of bulging pseudocysts, whereas EUD should be preferred for nonbulging pseudocysts.

References

  • 1 Howell D A, Elton E, Parsons W G. Endoscopic management of pseudocysts of the pancreas.  Gastrointest Endosc Clin N Am. 1998;  8 143-162
    Google Scholar
  • 2 Monkemuller K E, Baron T H, Morgan D E. Transmural drainage of pancreatic fluid collections without electrocautery using the Seldinger technique.  Gastrointest Endosc. 1998;  48 195-200
    PubMedGoogle Scholar
  • 3 Baron T H. Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis.  Gastrointest Endosc Clin N Am. 2003;  13 743-764
    CrossrefPubMedGoogle Scholar
  • 4 Yusuf T E, Baron T H. Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members.  Gastrointest Endosc. 2006;  63 223-227
    Google Scholar
  • 5 Cahen D, Rauws E, Fockens P. et al . Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment.  Endoscopy. 2005;  37 977-983
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Chahal P, Papachristou G I, Baron T H. Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: success and complication rates.  Surg Endosc. 2007;  21 1726-1732
    CrossrefPubMedGoogle Scholar
  • 7 Varadarajulu S, Wilcox C M, Tamhane A. et al . Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage.  Gastrointest Endosc. 2007;  66 1107-1119
    Google Scholar
  • 8 Binmoeller K F, Soehendra N. Endoscopic ultrasonography in the diagnosis and treatment of pancreatic pseudocysts.  Gastrointest Endosc Clin N Am. 1995;  5 805-816
    PubMedGoogle Scholar
  • 9 Fockens P. EUS in drainage of pancreatic pseudocysts.  Gastrointest Endosc. 2002;  56 S93-97
    CrossrefPubMedGoogle Scholar
  • 10 Sriram P V, Kaffes A J, Rao G V, Reddy D N. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts complicated by portal hypertension or by intervening vessels.  Endoscopy. 2005;  37 231-235
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Ahlawat S K, Charabaty-Pishvaian A, Jackson P G, Haddad N G. Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients.  JOP. 2006;  7 616-624
    Google Scholar
  • 12 Antillon M R, Shah R J, Stiegmann G, Chen Y K. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts.  Gastrointest Endosc. 2006;  63 797-803
    Google Scholar
  • 13 Azar R R, Oh Y S, Janec E M. et al . Wire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope.  Gastrointest Endosc. 2006;  63 688-692
    CrossrefPubMedGoogle Scholar
  • 14 Kahaleh M, Shami V M, Conaway M R. et al . Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage.  Endoscopy. 2006;  38 355-359
    Google Scholar
  • 15 Baron T H. Drainage of pancreatic fluid collections: is EUS really necessary?.  Gastrointest Endosc. 2007;  66 1123-1125
    CrossrefPubMedGoogle Scholar
  • 16 Vazquez-Sequeiros E. Drainage of peripancreatic-fluid collections: is EUS really necessary?.  Gastrointest Endosc. 2007;  66 1120-1122
    CrossrefPubMedGoogle Scholar
  • 17 Barthet M, Lamblin G, Gasmi M. et al . Clinical usefulness of a treatment algorithm for pancreatic pseudocysts.  Gastrointest Endosc. 2008;  67 245-252
    Google Scholar
  • 18 Varadarajulu S, Tamhane A, Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video).  Gastrointest Endosc. 2008;  68 656-666
    CrossrefPubMedGoogle Scholar
  • 19 Varadarajulu S. EUS followed by endoscopic pancreatic pseudocyst drainage or all-in-one procedure: a review of basic techniques (with video).  Gastrointest Endosc. 2009;  69 S176-S181
    CrossrefPubMedGoogle Scholar
  • 20 Bradley 3rd E L. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, 11–13 September 1992.  Arch Surg. 1993;  128 586-590
    PubMedGoogle Scholar
  • 21 Harewood G C, Wright C A, Baron T H. Impact on patient outcomes of experience in the performance of endoscopic pancreatic fluid collection drainage.  Gastrointest Endosc. 2003;  58 230-235
    CrossrefPubMedGoogle Scholar
  • 22 Kruger M, Schneider A S, Manns M P, Meier P N. Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access.  Gastrointest Endosc. 2006;  63 409-416
    CrossrefPubMedGoogle Scholar
  • 23 Varadarajulu S, Christein J D, Tamhane A. et al . Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos).  Gastrointest Endosc. 2008;  68 1102-1111
    CrossrefPubMedGoogle Scholar
  • 24 Kozarek R A. Endoscopic therapy of complete and partial pancreatic duct disruptions.  Gastrointest Endosc Clin N Am. 1998;  8 39-53
    PubMedGoogle Scholar
  • 25 Lawrence C, Howell D A, Stefan A M. et al . Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of long-term follow-up.  Gastrointest Endosc. 2008;  67 673-679
    Google Scholar
  • 26 Pelaez-Luna M, Vege S S, Petersen B T. et al . Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases.  Gastrointest Endosc. 2008;  68 91-97
    CrossrefPubMedGoogle Scholar

S. S. LeeMD, PhD 

Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center

388-1 Pung-nap2 dong
Songpa-gu
138-736
Seoul
South Korea

Fax: +82-2-4760824

Email: ssleedr@amc.seoul.kr