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

Yang, Dennis; Amin, Sunil; Gonzalez, Susana; Mullady, Daniel; Hasak, Stephen; Gaddam, Srinivas; Edmundowicz, Steven A.; Gromski, Mark A.; DeWitt, John M.; Zein, Mohamad El; Khashab, Mouen A.; Wang, Andrew Y.; Gaspar, Jonathan; Uppal, Dushant; Nagula, Satish; Kapadia, Samir; Buscaglia, Jonathan M.; Bucobo, Juan Carlos; Schlachterman, Alex; Wagh, Mihir S.; Draganov, Peter V.; Jung, Min Kyu; Stevens, Tyler; Vargo, John J.; Khara, Harshit S.; Huseini, Mustafa; Diehl, David L.; Keswani, Rajesh N.; Law, Ryan; Komanduri, Srinadh; Yachimski, Patrick; DaVee, Tomas; Prabhu, Anoop; Lapp, R; Kwon, Richard S.; Watson, Rabindra R.; Goodman, Adam; Chhabra, Natasha; Wang, Wallace J.; Benias, Petros C.; Carr‐Locke, David L.; DiMaio, Christopher J.

doi:10.1016/j.gie.2015.10.040

Cited by 95 publications

(61 citation statements)

References 27 publications

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“…More importantly, there was no difference in the long-term rates of symptomatic resolution (69% vs. 62%, p =0.61) or complete radiological resolution (71% vs. 67%, p =0.79) between transmural and combined approaches, respectively. In fact, attempts at transpapillary drainage were negatively associated with long-term resolution [40]. Therefore, based on this latest evidence, routine transpapillary drainage for PFCs is not recommended.…”

Section: Transpapillary Drainagementioning

confidence: 99%

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

et al. 2017

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Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.

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Section: Transpapillary Drainagementioning

confidence: 99%

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

et al. 2017

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“…Transmural drainage has gradually become the preferred therapeutic approach for managing pseudocysts, including the advantages of cystogastrostomy or cystoduodenostomy (internal drainage)[16]. A recent multicenter retrospective study found that transpapillary drainage of pseudocysts in patients undergoing EUS-guided transmural drainage added no benefit to outcomes and adversely affected resolution of the pseudocyst[67]. …”

Section: Outcomes After Different Management Plansmentioning

confidence: 99%

Management of patients after recovering from acute severe biliary pancreatitis

Dedemadi

Nikolopoulos

Kalaitzopoulos

et al. 2016

WJG

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Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature.

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“…In such cases, combined endoscopic transmural and transpapillary drainage may have benefit over single approach modality [48]. However, another study could not find any benefit from combination of transpapillary and transmural over transmural drainage alone [49], and at the moment, the use of this combined approach remains ambiguous.…”

Section: Management Of Acute Peripancreatic Fluid Collections and Panmentioning

confidence: 99%

Management of (Peri)Pancreatic Collections in Acute Pancreatitis

et al. 2019

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The development of (peri)pancreatic fluid collections are frequent local complications in acute pancreatitis. These collections are classified as early (acute peripancreatic fluid collection or acute necrotic collection) or late (walled-off necrosis or pseudocyst). The majority of pancreatic fluid collections resolve spontaneously and do not require intervention. However, infection may require intervention. Interventions may include endoscopic or percutaneous catheter drainage, or in a next step endoscopic or surgical necrosectomy, minimally invasive or open. The best timing for the first intervention is still under investigation. Whereas some use antibiotics to postpone intervention until the stage of walled-off necrosis, others drain earlier. Endoscopic drainage of (peri)pancreatic fluid collections is now the preferred approach of drainage due to reduced morbidity as compared to surgical or percutaneous drainage. However, each collection must be treated according to a tailored approach. The final treatment should take into consideration anatomic characteristics, patient preference, comorbidity profile of the patient, and physician discretion. This review summarizes the current evidence on the treatment of (peri)pancreatic fluid collections.

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

Cited by 95 publications

References 27 publications

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

Management of patients after recovering from acute severe biliary pancreatitis

Management of (Peri)Pancreatic Collections in Acute Pancreatitis

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