ENDOSCOPIC DRAINAGE OF PANCREATIC AND PERI-PANCREATIC COLLECTIONS: A RETROSPECTIVE ANALYSIS

Aims Pancreatic/peri-pancreatic fluid collections (PFC) are a common complication of acute or chronic pancreatitis. Symptomatic pseudocysts (PP) and encapsulated necrotic collections (WOPN) require treatment, being endoscopic drainage one of the therapeutic options. The aim of this study is evaluating the efficacy and safety of endoscopic drainage in the treatment of PP and WOPN.

Methods Retrospective analysis from 44 patients (male-27; mean age-58.2 ± 13.3 years) with symptomatic PFC, who underwent endoscopic drainage from 2006 to 2019. The procedure was performed under echoendoscopic control in 22 patients, and by direct puncture of gastric or duodenal compression determined by the collection in the remaining ones. Technical success, clinical success and complication rate were evaluated. Moreover, potential factors associated with clinical failure were also accessed.

Results Over the period given, 21 patients with PP and 23 with WOPN were assigned to endoscopic drainage. Five patients had already undergone an unsuccessful percutaneous drainage, and other 3 had been surgically intervened with subsequent recurrence of PFC. The average size of the collections was 13.6 ± 6.5 cm and the average length of stay was 35.4 ± 30.8 days. Endoscopic drainage was technically successful in 90.9% of the cases and clinical resolution was achieved in 77.5% of them. Necrosectomy sessions were performed in 15 patients (68.2% of those with WOPN) and complications occurred in 17 patients (38.6%).

Despite being a small sample, the etiology seems to be related to the type of collection observed, and both lithiasis and previous performance of ERCP seem to be more associated with the onset of WOPN. Chronic pancreatitis seems to be more related to PP (p < 0.006).

Conclusions Endoscopic drainage of PFC is a slightly invasive procedure with a very acceptable clinical success rate. However, it might be associated with complications, some of them significant, and associated with technical failure. Surgery may be indispensable in this specific context.