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Gastrointest Endosc. 2016 Apr;83(4):720-9. doi: 10.1016/j.gie.2015.10.040. Epub 2015 Nov 6.

Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study.

Author information

1
Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
2
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
3
Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
4
Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
5
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA.
6
Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA.
7
Division of Gastroenterology, University of Florida, Gainesville, Florida, USA.
8
Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
9
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
10
Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
11
Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
12
Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
13
Division of Digestive Diseases, University of California at Los Angeles School of Medicine, Los Angeles, California, USA.
14
Division of Gastroenterology, New York University School of Medicine, New York, New York, USA.
15
Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA.

Abstract

BACKGROUND AND AIMS:

The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution.

METHODS:

This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression.

RESULTS:

A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P = .0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P = .23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P = .37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P = .61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P = .79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P = .03).

CONCLUSIONS:

TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.

PMID:
26548849
DOI:
10.1016/j.gie.2015.10.040
[Indexed for MEDLINE]
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