Our results with endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFC)

Background: The management of PFCs has changed over the last decades. The surgical approach at certain criteria was turned into the minimal invasive technologies such as endoscopy- or EUS-guided drainage. EUS has the advantage that the interposed vessels could be passed by and the majority of the non-bulging cysts could be drained. In our study we prospectively collected and analyzed our data between 2010 and 2014.

Method: 38 pts were referred to PFC drainage and 34 (9 women, 7 walled-off pancreatic necrosis (WOPN) and 27 pseudocysts) underwent the EUS-guided operation, but in 4 the non-bulging PFCs were far from the lumen to be safely drained. If the drainage was performed through the transluminar way, a 10 F cystostome was used to get into the PFC under EUS (EG530UT, Fujinon, Japan)-guidance than two guidewires were inserted simutaneously. After balloon dilation 1 – 2 (1.54) double-pigtail 7 to 10 F-sized plastic stents were placed into the PFC. Nasocystic drain was also inserted for 2 – 10 days to all pts with WOPN or pseudocysts with consistent fluid content. All 4 pts, who had transpapillary drainage got only one 7 F double pigtail stent after sphincterotomy. The pts were followed-up with laboratory tests and abdominal ultrasound. The stents were removed 3 months after the initial examination.

Results: The average size of PFCs were 11.35 cm (6 – 20). Four drainages were performed through the papilla, 2 transduodenally and 28 in a transgastric way under EUS control. 12 from the 16 (75%) non-bulging PFCs could be drained. Four of our pts (11.8%) had complications after the endoscopy: two mild, spontaneously-stopped bleedings from the pseudocysts and two abdominal perforations that had to be managed surgically, both of them had non-bulging PFCs. We lost 2 pts from the follow-up, but the average of the remaining 32 pts' follow-up time was 8 months (1 – 28). No procedure-related death was observed. 5 pts died during the follow up: two because of unrelated diseases but 3 (all of them had WOPN) because of late complications of the necrotizing pancreatitis within 1 – 2.5 months after the endoscopy. All but two surviving pts had no recidive pseudocysts (94%) at the end of the follow-up period.

Conclusion: The EUS-guided drainage of these high risk patients with large PFCs is effective and safe minimal invasive endoscopic procedure with only a minimal recurrence rate. The EUS has the clear advantage that the majority of the non-bulging PFCs could be successfully drained.