Endosonograficky navigovaná drenáž pankreatických kolekcí
– vlastní zkušenosti

Česká verzia

Authors: K. Poc ¹; P. Mačinga ²; P. Štirand ²; P. Wohl ²; P. Drastich ² ; J. Martínek ²; P. Taimr ²; V. Nosek ³ ; J. Špičák ²; T. Hucl ²
Authors place of work: 1. LF UK v Praze ¹; Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha ²; Gastroenterologie, Nemocnice Jablonec nad Nisou, p. o. ³
Published in the journal: Gastroent Hepatol 2017; 71(5): 401-408
Category: Gastrointestinální onkologie: původní práce
doi: https://doi.org/10.14735/amgh2017401

Summary

Background:
Endosonography (EUS) -guided drainage is a commonly used method for the treatment of symptomatic pancreatic fluid collections, such as pancreatic pseudocyst (PC) and walled-off pancreatic necrosis (WOPN). Data on efficiency and complication rates are heterogenous.

Patients and Methods:
We conducted a retrospective study of all patients who underwent EUS-guided drainage between January, 2000, and December, 2016, at our department. We evaluated their clinical data, indications, course of procedures, complications, and treatment outcomes.

Results:
Among 104 patients who underwent EUS-guided drainage, 76 (73%) were treated for a pseudocyst and 28 (27%) patients for a walled-off pancreatic necrosis. PC developed as a result of chronic (53%) or acute (42%) pancreatitis. The average size of PC was 9 ± 4.8 cm. Drainage was performed transgastrically (62%), transduodenally (17%), or transpapillary (21%). Patients were treated with plastic (91%) or metal (9%) stents. The technical success rate was 93%. PC resolution occurred in 75% of cases with a median drainage duration of 64 (1–1,744) days. The clinical success rates of plastic and metal stents were 72% and 100%, resp. (p = 0.319). Reported complications were bleeding (4), perforation (5), and secondary infections (8). WOPN developed as a result of acute (89%) or exacerbation of chronic (11%) pancreatitis. The average size of WOPN was 11 ± 5.8 cm. WOPN drainage was performed transgastrically (93%) or tranduodenally (7%). Patients were treated with plastic stents (73%), metal stents (21%), or a combination of both (8%). Technical success rate was 96%. Endoscopic necrectomy was performed on 9 patients (32%). Resolution of WOPN occurred in 77% of cases with a median drainage duration of 69 (1–1,210) days. Clinical success rates using plastic and metal stents were 71% and 100%, resp. (p = 0.289). Encountered complications were bleeding (1), perforation (1), and secondary infections (3).

Conclusion:
EUS-guided drainage was an effective method for the treatment of pancreatic fluid collections with a significant rate of complications. Its effectiveness was not influenced by the type of collection; the trend of better clinical success rate using metal stents did not reach statistical significance.

Key words:
pancreatic fluid collection – pseudocyst – walled-off pancreatic necrosis – endosonography – drainage

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
24. 9. 2017

Accepted:
27. 9. 2017

Zdroje

1. Banks PA, Bollen TL, Dervenis C et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62 (1): 102–111. doi: 10.1136/gutjnl-2012-302779.

2. Tyberg A, Karia K, Gabr M et al. Management of pancreatic fluid collections: a comprehensive review of the literature. World J Gastroenterol 2016; 22 (7): 2256–2270. doi: 10.3748/wjg.v22.i7. 2256.

3. Lenhart DK, Balthazar EJ. MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections. AJR Am J Roentgenol 2008; 190 (3): 643–649. doi: 10.2214/AJR.07. 2761.

4. Baillie J. Pancreatic pseudocysts (Part I). Gastrointestinal Endosc 2004; 59 (7): 873–879.

5. Kim KO, Kim TN. Acute pancreatic pseudocyst: incidence, risk factors, and clini-cal outcomes. Pancreas 2012; 41 (4): 577–581. doi: 10.1097/MPA.0b013e3182 374def.

6. Špičák J, Urban O (eds). Novinky v digestivní endoskopii. Praha: Grada 2015.

7. Grimm H, Binmoeller KF, Soehendra N. Endosonography-guided drainage of a pan-creatic pseudocyst. Gastrointestinal Endosc 1992; 38 (2): 170–171.

8. Akshintala VS, Saxena P, Zaheer A et al. A comparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts. Gastrointest Endosc 2014; 79 (6): 921–928. doi: 10.1016/j.gie.2013.10. 032.

9. Varadarajulu S, Bang JY, Sutton BS et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013; 145 (3): 583–590. doi: 10.1053/j.gastro.2013.05.046.

10. Varadarajulu S, Christein JD, Tamhane A et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008; 68 (6): 1102–1111. doi: 10.1016/j.gie.2008.04.028.

11. Park DH, Lee SS, Moon SH et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 2009; 41 (10): 842–848. doi: 10.1055/s-0029-1215133.

12. Kliment M, Urban O, Fojtík P et al. Endoskopická drenáž pankreatických tekutinových kolekcií – 6-ročná skúsenosť v terciárnom gastroenterologickom centre v období rokov 2006–2012. Gastroent Hepatol 2017; 71 (3): 199–207. doi: 10.14735/amgh2017199.

13. Varadarajulu S, Bang JY, Phadnis MA. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg 2011; 15 (11): 2080–2088. doi: 10.1007/s11605-011-1621-8.

14. Nabi Z, Basha J, Reddy DN. Endoscopic management of pancreatic fluid collections-revisited. World J Gastroenterol 2017; 23 (15): 2660–2672. doi: 10.3748/wjg.v23.i15.2660.

15. Cahen D, Rauws E, Fockens P et al. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and success-ful treatment. Endoscopy 2005; 37 (10): 977–983.

16. Seifert H, Biermer M, Schmitt W et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009; 58 (9): 1260–1266. doi: 10.1136/gut.2008.163733.

17. Gardner TB, Coelho-Prabhu N, Gordon SR et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc 2011; 73 (4): 718–726.

18. Holt BA, Varadarajulu S. The endoscopic management of pancreatic pseudocysts (with videos). Gastrointest Endosc 2015; 81 (4): 804–812. doi: 10.1016/j.gie.2014.12.026.

19. Baron TH, Harewood GC, Morgan DE et al. Outcome differences after endo-scopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 2002; 56 (1): 7–17.

20. Siddiqui AA, Kowalski TE, Loren DE et al. Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc 2017; 85 (4): 758–765. doi: 10.1016/j.gie.2016.08.014.

21. Sharaiha RZ, DeFilippis EM, Kedia P et al. Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc 2015; 82 (5): 822–827. doi: 10.1016/j.gie.2015.02. 035.

22. Bang JY, Hawes R, Bartolucci A et al. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: a systematic review. Dig Endosc 2015; 27 (4): 486–498. doi: 10.1111/den.12 418.

23. van Santvoort HC, Besselink MG, Bakker OJ et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362 (16): 1491–1502. doi: 10.1056/NEJMoa0908821.

24. Lakhtakia S, Basha J, Talukdar R et al. Endoscopic „step-up approach“ using a dedicated biflanged metal stent reduces the need for direct necrosectomy in walled-off necrosis (with videos). Gastrointest Endosc 2017; 85 (6): 1243–1252. doi: 10.1016/j.gie.2016.10.037.

25. Bang JY, Hasan M, Navaneethan U et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2016. In press. doi: 10.1136/gutjnl-2016-312812.

26. van Brunschot S, Fockens P, Bakker OJ et al. Endoscopic transluminal necro-sectomy in necrotising pancreatitis: a systematic review. Surg Endosc 2014; 28 (5): 1425–1438. doi: 10.1007/s00464-013-3382-9.