Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2017; 23(39): 7110-7118
Published online Oct 21, 2017. doi: 10.3748/wjg.v23.i39.7110
Short- and long-term results of endoscopic ultrasound-guided transmural drainage for pancreatic pseudocysts and walled-off necrosis
Yuto Watanabe, Rintaro Mikata, Shin Yasui, Hiroshi Ohyama, Harutoshi Sugiyama, Yuji Sakai, Toshio Tsuyuguchi, Naoya Kato
Yuto Watanabe, Rintaro Mikata, Shin Yasui, Hiroshi Ohyama, Harutoshi Sugiyama, Yuji Sakai, Toshio Tsuyuguchi, Naoya Kato, Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba 260-8670, Japan
Author contributions: Watanabe Y and Mikata R designed research; Watanabe Y, Mikata R, Yasui S, Ohyama H, Sugiyama H, Sakai Y and Tsuyuguchi T acquired the data; Watanabe Y and Mikata R analyzed and interpreted data; Watanabe Y drafted the manuscript; Mikata R and Kato N made critical revisions related to important intellectual content of the manuscript; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Chiba University Institutional Review Board.
Informed consent statement: In this retrospective study, written informed consent was not provided by the participants, but the documents explaining how the data included in this study would be used were displayed on the bulletin board in Chiba University Hospital.
Conflict-of-interest statement: The authors have no conflicts to disclose. All authors disclosed no financial relationships relevant to this publication.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rintaro Mikata, MD, PhD, Associate Professor, Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo Ward, Chiba 260-8670, Japan. mikata@faculty.chiba-u.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: August 2, 2017
Peer-review started: August 11, 2017
First decision: August 30, 2017
Revised: September 12, 2017
Accepted: September 26, 2017
Article in press: September 26, 2017
Published online: October 21, 2017
Processing time: 79 Days and 18.6 Hours
Abstract
AIM

To evaluate the short- and long-term results of endoscopic ultrasound-guided transmural drainage (EUS-GTD) for pancreatic fluid collection (PFC) and identify the predictive factors of treatment outcome for walled-off necrosis (WON) managed by EUS-GTD alone.

METHODS

We investigated 103 consecutive patients with PFC who underwent EUS-GTD between September 1999 and August 2015. Patients were divided into four groups as follows: WON (n = 40), pancreatic pseudocyst (PPC; n = 11), chronic pseudocyst (n = 33), and others (n = 19). We evaluated the short- and long-term outcomes of the treatment. In cases of WON, multiple logistic regression analyses were performed to identify the predictor variables associated with the treatment success. In addition, PFC recurrence was examined in patients followed up for more than 6 mo and internal stent removal after successful EUS-GTD was confirmed.

RESULTS

In this study, the total technical success rate was 96.1%. The treatment success rate of WON, PPC, chronic pseudocyst, and others was 57.5%, 90.9%, 91.0%, and 89.5%, respectively. Contrast-enhanced computed tomography using the multivariate logistic regression analysis revealed that the treatment success rate of WON was significantly lower in patients with more than 50% pancreatic parenchymal necrosis (OR = 17.0; 95%CI: 1.9-150.7; P = 0.011) and in patients with more than 150 mm of PFC (OR = 27.9; 95%CI: 3.4-227.7; P = 0.002).The recurrence of PFC in the long term was 13.3% (median observation time, 38.8 mo). Mean amylase level in the cavity was significantly higher in the recurrence group than in the no recurrence group (P = 0.02).

CONCLUSION

The reduction of WON by EUS-GTD alone was associated with the proportion of necrotic tissue and extent of the cavity. The amylase level in the cavity may be a predictive factor for recurrence of PFC.

Keywords: Endoscopic ultrasound-guided transmural drainage; Pancreatic fluid collection; Revised Atlanta Classification; Walled-off necrosis

Core tip: It remains unclear that which patients with walled-off necrosis (WON) can be resolved by endoscopic ultrasound-guided transmural drainage (EUS-GTD) alone and which ones should be treated by endoscopic necrosectomy or other additional treatment. In addition, some pancreatic fluid collections (PFCs) develop recurrent fluid collection, and it is also unclear which types of PFCs show recurrence. In this study, we demonstrated that PFC size and proportion of pancreatic parenchymal necrosis were related to the resolution of WON treated by EUS-GTD alone. Regarding long-term follow-up patients, mean amylase level in the cavity was associated with PFC recurrence, suggesting a prolonged stent placement in patients with predicted recurrence.