EUS-guided drainage of pancreatic fluid collections (PFCs): assessment of outcomes in 132 consecutive patients

Background: Unlike fine needle aspirations (FNAs), data on the clinical outcomes and complications of EUS-guided drainage of PFCs is limited due to the small number of patients, varied procedural techniques and multiple operators. Aim: Evaluate the treatment outcomes and complications of EUS-guided drainage of PFCs in a large cohort of patients using a standardized technique. Methods: Clinical outcomes of all patients who underwent EUS-guided drainage of PFCs over a 7 year period was assessed from a prospective database. Prior to EUS, an ERCP was attempted for pancreatic stent placement in all patients with a duct disruption. All procedures were performed by one endoscopist using a standard one step dilation technique. At EUS, after coiling a 0.035 inch guidewire and dilating the transmural tract, two or three 7Fr stents were deployed. Additional nasocystic catheters were deployed in patients with abscess or necrotic fluid collections. Results: A total of 132 patients (mean age 49.9yrs, [range 9–76], Male 78) underwent EUS-guided drainage of PFCs that were classified as pseudocyst in 68, abscess 32 and necrosis in 32. Forty nine patients (37.1%) underwent pancreatic stent placement at ERCP. The mean diameter of the PFCs was 94mm (range, 40–220mm) and 23 patients had undergone prior therapy (surgery 7, percutaneous drainage 16). Mean duration of follow-up was 197 days. Successful resolution of symptoms occurred in 86% of patients. Compared to pseudocysts and abscesses, treatment failure rate was higher for drainage of necrotic collections (4.1 vs. 40.6%, p=0.0002). Complication of perforation occurred in 2 patients (frequency 1.5%, 95% CI [0.2%, 5%]), bleeding 1 (0.7%, 95% CI[0.1%, 4%]), infection 6 (4.5%, 95% CI [2.1%, 9.5%]) and stent migration in 1 (0.7%, 95% CI [0.1%, 4%]). There were three deaths from multi-organ dysfunction within 30 days of EUS of which none were procedure related. Conclusions: EUS-guided drainage of pancreatic fluid collections is successful in a majority of patients with a low complication rate. The technique is best suited for drainage of non-necrotic collections.