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.
Abbreviations:
ASGE (American Society for Gastrointestinal Endoscopy), CD (combined drainage), CI (confidence interval), ERP (endoscopic retrograde pancreatography), IQR (interquartile range), LT (long-term), OR (odds ratio), PD (pancreatic duct), PFC (pancreatic fluid collection), ST (short-term), TMD (transmural drainage), TPD (transpapillary drainage)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 05, 2015
Accepted:
October 29,
2015
Received:
July 26,
2015
Footnotes
DISCLOSURES: Dr Wang receives research funding from Cook Medical. Dr Edmundowicz is a consultant for Olympus America and Boston Scientific and receives research funding from Boston Scientific. Dr Khashab is a consultant for Boston Scientific. Dr Yachimski is a consultant for Boston Scientific. Dr Keswani is a consultant for Boston Scientific and Cook Medical. Dr Vargo is a consultant for Covidien. Dr Law is a consultant for Covidien Dr Stevens is a consultant for Boston Scientific. Dr DiMaio is a consultant for Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 808.
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Transmural drainage versus transpapillary stenting and transmural drainage: not an open and shut case…yetGastrointestinal EndoscopyVol. 83Issue 5
- PreviewWe read with interest the retrospective study comparing transmural drainage (n = 95) of pseudocysts with combined transmural/transpapillary drainage technique (n = 79).1 Although there was no difference in the clinicoradiologic resolution of pseudocysts, an attempt at transpapillary intervention negatively impacted long-term resolution. As the authors point out, of 79 patients, a pancreatogram was successful in 66, of whom only 6 had a normal duct. Of the remaining 60 patients, 47 had ductal leak/disruption and 28 had stones/strictures with/without a leak/disruption; 17 patients underwent bridging stent placement.
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- Endoscopic transmural drainage versus combined transmural and transpapillary drainage in pseudocystsGastrointestinal EndoscopyVol. 84Issue 3
- PreviewWe read with interest the elegant multicenter study by Yang et al1 in which they compared endoscopic transmural drainage (TMD) alone with combined transmural and transpapillary drainage (CD) in patients with pseudocysts. Pancreatic pseudocysts (PP) are invariably associated with pancreatic duct (PD) disruption, and TMD does not directly treat the PD disruption. Theoretically, bridging of the PD disruption by stenting would act synergistically and improve the treatment outcomes of transmural drainage.
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- Transpapillary drainage has a major benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocystsGastrointestinal EndoscopyVol. 83Issue 5
- PreviewWe read with interest the study by Yang et al1 evaluating the role of transpapillary (TP) drainage in the management of pancreatic pseudocysts. The article concludes that TP drainage provides no additional benefit to transmural (TM) drainage and consequently has no role in the management of pancreatic pseudocysts. However, the data provided do not justify this conclusion.
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- Does transpapillary drainage really have no added benefit on treatment outcomes in patients undergoing transmural drainage of pancreatic fluid collections?Gastrointestinal EndoscopyVol. 84Issue 5
- PreviewWe congratulate Yang et al1 on an interesting publication and surprising results. This retrospective, multicenter research study suggests that transpapillary drainage (TPD) has no benefit on treatment outcomes in patients undergoing transmural drainage (TMD) of pancreatic pseudocysts. The negative effect of TPD on the long-term resolution of pancreatic fluid collections (PFCs) is particularly surprising. The results are contrary to those in current reports on the usefulness and effectiveness of stent placement in the pancreatic duct (PD) in patients with PFCs.
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