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: Gastrointestinal Oncology: Original Article
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

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