EUS-guided transmural drainage of pancreatic fluid collections in 93 patients

Background and Aim. EUS-guided transmural drainage (EUS-GTD) of pancreatic fluid collections (PFC) has been reported to be effective. We evaluated the feasibility of the EUS-GTD in the patients with PFC. Methods. 93 patients (68 males, 25 females, mean age 53.0 years) who were performed EUS-GTD of PFC from 1999 to 2013 were investigated. We examined retrospectively patient characteristics, etiology, technical success, clinical success, and complications. Results. The mean diameter of PFC was 94.4mm. The etiology of the PFC included acute pancreatitis (n = 45), chronic pancreatitis (n = 38), trauma (n = 5), pancreatic cancer (n = 3), pancreatic fistula after pancreatic surgery (n = 2). Total technical success rate was 83.9%. Clinical success was achieved in 84.6% of internal and external drainage, 84.6% of internal drainage, 92.3% of external drainage, and 62.5% of puncture and aspiration. Complications were encountered in 14 (15.1%). All 14 patients were treated conservatively without surgery. According to revision of the Atlanta classification and definitions, PFCs in 36 patients were categorized walled-off necrosis (WON). The patients with WON, with more than 50% pancreatic parenchymal necrosis (p=0.005) and the size of PFC more than 15cm (p=0.04) significantly required other therapy (percutaneous drainage or endoscopic necrosectomy or surgery). Conclusions. EUS-GTD is successful and relatively safe therapeutic technique in the majority of patients with PFC.