Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video) - 23/08/11
Reprint requests: Shyam Varadarajulu, MD, Division of Gastroenterology-Hepatology, University of Alabama at Birmingham Medical Ctr, 410 LHRB, 1530 3rd Ave S, Birmingham, AL 35294.Birmingham, Alabama, USA
Abstract |
Background |
Although the utility and safety of EUS and EUS-guided FNA is well known, there is a need for more data on outcomes and complications of EUS-guided drainage procedures.
Objective |
To evaluate the rates of technical success, treatment success, and complications of the graded dilation technique for performing EUS-guided drainage of peripancreatic fluid collections (PFCs) in a large cohort of patients. Also, the technical proficiency for performing EUS-guided drainage of PFCs was evaluated.
Design |
A prospective study of all patients undergoing EUS-guided drainage of PFC.
Setting |
A tertiary-referral center.
Interventions |
After passage of a 0.035-inch guidewire into the PFC by using a 19-gauge needle, graded dilation of the tract was sequentially performed by using a 4.5F ERCP cannula, a 10F ERCP inner guiding catheter, and an 8-mm balloon dilator. A transmural stent and/or drainage catheter was then deployed.
Main Outcome Measurements |
To evaluate the technical success, treatment success, and complications of the graded dilation technique. Technical proficiency was evaluated by comparing the procedural duration between the first 25 cases (group A), with a later cohort of patients (group B, n = 29) who underwent EUS-guided drainage of a single PFC.
Results |
Sixty patients (41 men; mean age 51 years [range 20-79 years], 6 multiple PFCs) underwent EUS-guided drainage of a PFC (types included 36 pseudocyst, 15 abscess, and 9 necrosis) over a 42-month period. The rates of technical and treatment success were 95% and 93%, respectively. A minor complication of stent migration was encountered in 1 of 60 patients (1.7%). There was no significant difference in patient or clinical characteristics between group A and B patients who were undergoing drainage of a single PFC. Although there was no significant difference in technical or treatment outcome, median procedural duration was significantly shorter for group B than for group A patients (25 vs 70 minutes; P < .001). Procedural duration for performing EUS-guided drainage of a single PFC was more likely to be <30 minutes in group B than in group A patients (crude odds ratio [OR] 18.8; P < .001), which remained significant (adjusted OR 11.8; P = .01), even after adjusting for patient age; serum albumin; type, location, and size of PFCs; drainage modality (stent vs stent plus drainage catheter); and site of endoscopic access for establishing drainage.
Conclusions |
In this study, EUS-guided drainage of a PFC could be performed safely by using the graded dilation technique, with a successful outcome in a majority of patients. Technical proficiency, with regard to procedural duration, improved significantly after the first 25 cases.
Le texte complet de cet article est disponible en PDF.Abbreviations : OR, PFC
Plan
Vol 68 - N° 4
P. 656-666 - octobre 2008 Retour au numéro
Article précédent
- EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts
- Shyam Varadarajulu, Tercio L. Lopes, C. Mel Wilcox, Ernesto R. Drelichman, Meredith L. Kilgore, John D. Christein
- Clinical outcomes and nonendoscopic interventions after minor papilla endotherapy in patients with symptomatic pancreas divisum
- Lyssa N. Chacko, Yang K. Chen, Raj J. Shah
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