Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage

Arvanitakis, Marianna; Delhaye, Myriam; Bali, Maria Antonietta; Matos, Celso; Maertelaer, Viviane De; Moine, Olivier Le; Devière, Jacques

doi:10.1016/j.gie.2006.06.083

Cited by 260 publications

(207 citation statements)

References 38 publications

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“…Furthermore, as shown in a subgroup analysis in this study, even when a PD stent is successfully placed across the leak/disruption in patients who undergo CD, there was no difference in treatment outcomes when compared with patients who underwent TM alone. Thus, although there is a paucity of studies that have directly evaluated PD disruption and healing after TM alone, the positive clinical outcomes associated with PFC resolution and low recurrence rates would suggest this to be an effective treatment modality in most patients with PD disruption, including those with a disconnected pancreatic duct syndrome [27,28]. Altogether, the low technical success rate of TP, the well-recognized potential adverse events associated with ERP, and the absence of definitive improved treatment outcomes with a combined drainage approach, suggests that TP has no benefit in patients with pseudocysts undergoing endoscopic TM.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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

Yang

Amin

Gonzalez

et al. 2016

Gastrointestinal Endoscopy

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Section: Accepted Manuscriptmentioning

confidence: 99%

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

Yang

Amin

Gonzalez

et al. 2016

Gastrointestinal Endoscopy

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“…They help in delineation of the anatomy and PFC. With expertise PFCs that have failed drainage by other methods and those in unusual locations are also considered for drainage [7,16,23] . Many experts recommend assessment of the main pancreatic duct at the time of PFC drainage with ERCP as uniden- tified pancreatic duct stricture or leak may result in failure of resolution or recurrence of PFC [16,24,25] .…”

Section: Prerequisites For Eus Drainagementioning

confidence: 99%

“…Patients needs follow up on four weekly basis with cross sectional imaging. All the stents can be removed after confirmation of the resolution of collection and after ensuring the integrity of pancreatic duct [23] . We routinely remove stent at three months and SEMS at 8 wk.…”

Section: Review Of Literaturementioning

confidence: 99%

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

Puri

Thandassery

Alfadda

et al. 2015

WJGE

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Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.

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“…A randomised trial suggested that long-term transenteric stenting in patients with disconnected pancreatic duct syndrome may be an alternative to surgery to prevent the recurrence of collection. (29) However, more data would be required to confirm this finding, given the concerns regarding stent occlusion and infection.…”

Section: Methodsmentioning

confidence: 91%

inShare Direct endoscopic necrosectomy: a minimally invasive endoscopic technique for the treatment of infected walled-off pancreatic necrosis and infected pseudocysts with solid debris

Kwek¹,

Tan²,

Ibrahim³

et al. 2013

SMedJ

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INTRODUCTION Endoscopic transenteric stenting is the standard treatment for pseudocysts, but it may be inadequate for treating infected collections with solid debris. Surgical necrosectomy results in significant morbidity. Direct endoscopic necrosectomy (DEN), a minimally invasive treatment, may be a viable option. This study examined the efficacy and safety of DEN for the treatment of infected walled-off pancreatic necrosis and infected pseudocysts with solid debris. METHODSThis study was a retrospective analysis of data collected from a prospective database of patients who underwent DEN in the presence of infected walled-off pancreatic necrosis or infected pseudocysts with solid debris from April 2007 to October 2011. DEN was performed as a staged procedure. Endoscopic ultrasonography-guided transgastric stenting was performed during the first session for initial drainage and to establish endoscopic access to the infected collection. In the second session, the drainage tract was dilated endoscopically to allow transgastric passage of an endoscope for endoscopic necrosectomy. Outcome data included technical success, clinical success and complication rates. RESULTSEight patients with infected walled-off pancreatic necrosis or infected pseudocysts with solid debris (mean size 12.5 cm; range 7.8-17.2 cm) underwent DEN. Underlying aetiologies included severe acute pancreatitis (n = 6) and post-pancreatic surgery (n = 2). DEN was technically successful in all patients. Clinical resolution was achieved in seven patients. One patient with recurrent collection opted for surgery instead of repeat endotherapy. No procedural complications were encountered.CONCLUSION DEN is a safe and effective minimally invasive treatment for infected walled-off pancreatic necrosis and infected pseudocysts.

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Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage

Cited by 260 publications

References 38 publications

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

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

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

inShare Direct endoscopic necrosectomy: a minimally invasive endoscopic technique for the treatment of infected walled-off pancreatic necrosis and infected pseudocysts with solid debris

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