Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm

다국어 초록 (Multilingual Abstract)

Background/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomaticpancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs andreport on its effcacy and safety.
Methods: Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs wereclassified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN).
Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm.
Results: A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwopatients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patientsachieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patientswith enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was fivetimes more likely to achieve resolution within 90 days (p=0.0069).
Conclusions: A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PDstenting, and early enteral feeding is adopted.

참고문헌 (Reference)

1 Seifert H, "Transluminal endoscopic necrosectomy after acute pancreatitis : a multicentre study with long-term follow-up(the GEPARD Study)" 58 : 1260-1266, 2009

2 Warshaw AL, "Timing of surgical drainage for pancreatic pseudocyst. Clinical and chemical criteria" 202 : 720-724, 1985

3 ASGE Standards of Practice Committee, "The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections" 83 : 481-488, 2016

4 Holt BA, "The endoscopic management of pancreatic pseudocysts(with videos)" 81 : 804-812, 2015

5 Trevino JM, "Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections" 25 : 526-531, 2010

6 Antillon MR, "Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts" 63 : 797-803, 2006

7 Varadarajulu S, "Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts(with videos)" 68 : 1102-1111, 2008

8 Penn DE, "Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts" 76 : 679-684, 2012

9 Aghdassi AA, "Pancreatic pseudocysts--when and how to treat?" 8 : 432-441, 2006

10 Ge PS, "Pancreatic pseudocysts : advances in endoscopic management" 45 : 9-27, 2016

11 Howard TJ, "Pancreatic duct strictures are a common cause of recurrent pancreatitis after successful management of pancreatic necrosis" 136 : 909-916, 2004

12 Bergman S, "Operative and nonoperative management of pancreatic pseudocysts" 87 : 1447-1460, 2007

13 Chang YS, "Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis : a meta-analysis" 17 : R118-, 2013

14 Rana SS, "Morphological features of fluid collections on endoscopic ultrasound in acute necrotizing pancreatitis : do they change over time?" 27 : 258-261, 2014

15 Tyberg A, "Management of pancreatic fluid collections : a comprehensive review of the literature" 22 : 2256-2270, 2016

16 Iso Y, "Intragastric stapled pancreatic pseudocystgastrostomy under endoscopic guidance" 23 : 330-333, 2013

17 Varadarajulu S, "Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial" 145 : 583-590.e1, 2013

18 Al-Omran M, "Enteral versus parenteral nutrition for acute pancreatitis" CD002837-, 2010

19 Li JY, "Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications : a meta-analysis" 8 : e64926-, 2013

20 Park DH, "Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts : a prospective randomized trial" 41 : 842-848, 2009

21 Kahaleh M, "Endoscopic ultrasound drainage of pancreatic pseudocyst : a prospective comparison with conventional endoscopic drainage" 38 : 355-359, 2006

22 Varadarajulu S, "Endoscopic transmural drainage of peripancreatic fluid collections : outcomes and predictors of treatment success in 211 consecutive patients" 15 : 2080-2088, 2011

23 Fisher JM, "Endoscopic therapy of necrotizing pancreatitis and pseudocysts" 23 : 787-802, 2013

24 Baron TH, "Endoscopic therapy for organized pancreatic necrosis" 111 : 755-764, 1996

25 Voermans RP, "Endoscopic management of walled-off pancreatic necrosis" 22 : 20-26, 2015

26 Ji Young Bang, "Endoscopic Ultrasound-Guided Management of Pancreatic Pseudocysts and Walled-Off Necrosis" 대한소화기내시경학회 47 (47): 429-431, 2014

27 Bang JY, "Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections : a systematic review" 27 : 486-498, 2015

28 Makola D, "Efficacy of enteral nutrition for the treatment of pancreatitis using standard enteral formula" 101 : 2347-2355, 2006

29 Aghdassi A, "Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis" 36 : 105-112, 2008

30 Neoptolemos JP, "Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis" 80 : 94-99, 1993

31 Seewald S, "Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess : a new safe and effective treatment algorithm(videos)" 62 : 92-100, 2005

32 Nealon WH, "A unifying concept : pancreatic ductal anatomy both predicts and determines the major complications resulting from pancreatitis" 208 : 790-799, 2009

33 Lau ST, "A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis" 181 : 411-415, 2001

34 Walter D, "A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections : a prospective cohort study" 47 : 63-67, 2015

35 van Santvoort HC, "A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome" 141 : 1254-1263, 2011