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

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 combine...

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Veröffentlicht in:	Gastrointestinal endoscopy 2016-04, Vol.83 (4), p.720-729
Hauptverfasser:	Yang, Dennis, MD, Amin, Sunil, MD, Gonzalez, Susana, MD, Mullady, Daniel, MD, Hasak, Stephen, MD, Gaddam, Srinivas, MD, Edmundowicz, Steven A., MD, Gromski, Mark A., MD, DeWitt, John M., MD, El Zein, Mohamad, MD, Khashab, Mouen A., MD, Wang, Andrew Y., MD, Gaspar, Jonathan P., MD, Uppal, Dushant S., MD, Nagula, Satish, MD, Kapadia, Samir, MD, Buscaglia, Jonathan M., MD, Bucobo, Juan Carlos, MD, Schlachterman, Alex, MD, Wagh, Mihir S., MD, Draganov, Peter V., MD, Jung, Min Kyu, MD, Stevens, Tyler, MD, Vargo, John J., MD, Khara, Harshit S., MD, Huseini, Mustafa, MD, Diehl, David L., MD, Keswani, Rajesh N., MD, Law, Ryan, DO, Komanduri, Srinadh, MD, Yachimski, Patrick S., MD, DaVee, Tomas, MD, Prabhu, Anoop, MD, Lapp, Robert T., MD, Kwon, Richard S., MD, Watson, Rabindra R., MD, Goodman, Adam J., MD, Chhabra, Natasha, MD, Wang, Wallace J., MD, Benias, Petros, MD, Carr-Locke, David L., MD, DiMaio, Christopher J., MD
Format:	Artikel
Sprache:	eng
Schlagworte:	Adult Aged Ampulla of Vater Cholangiopancreatography, Endoscopic Retrograde Drainage - adverse effects Drainage - methods Endosonography Female Follow-Up Studies Gastroenterology and Hepatology Humans Male Middle Aged Pancreatic Pseudocyst - diagnostic imaging Pancreatic Pseudocyst - surgery Retrospective Studies Stents - adverse effects Time Factors Treatment Outcome Ultrasonography, Interventional - adverse effects
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Zusammenfassung:	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.
ISSN:	0016-5107 1097-6779
DOI:	10.1016/j.gie.2015.10.040