Efficacy of Endoscopic Ultrasound-Guided Transmural Stent Drainage for Peripancreatic Fluid Collections: A Retrospective Analysis

Abstract

Introduction: Hospital admissions due to acute pancreatitis have risen by 20% worldwide and by 50% in the United States since 2000. Common complications of acute and chronic pancreatitis include peripancreatic fluid collections (PFCs) such as pancreatic pseudocysts and walled-off necrosis. Most PFCs disappear within 6 months, but up to 15% can persist. While treatment for symptomatic PFCs has historically been surgical, the advent of endoscopic transmural drainage-cystogastrostomy-has provided a less invasive treatment option. The aim of this study is to assess the efficacy of cystogastrostomy for symptomatic PFCs and identification of variables associated with clinical outcomes. Methods: We conducted a retrospective review of all cystogastrostomy cases done at our institution for symptomatic PFCs. Our primary outcome was change in PFC size. We also analyzed both baseline characteristics and clinical factors such as PFC location and transmural approach. An analysis of variance was done to test differences in mean reduction of PFC size among our clinical variables. We performed a simple regression analysis to assess correlation between outcomes and baseline characteristics. Results: A total of 15 patients underwent cystogastrostomies from January 2013 to April 2018. The median and mean observation period were 35 and 238 days, respectively. Cystogastrostomy resulted in improvement of PFC size in 93% (14/15) of the cohort and complete resolution thereof in 60% (9/15) at most recent follow up. A trans-gastric drainage approach was associated with greater reduction of PFC size when compared to trans-duodenal drainage (P-value 0.02). In addition, PFCs located within the head of the pancreas were associated with a smaller reduction in PFC size when compared to those located within the body and tail of pancreas. We did not see a significant difference in change of PFC size based on age, sex, use of plastic versus metal stents, or use of pre- versus post-procedure antibiotics. Conclusion: Cystogastrostomy is an effective treatment option for symptomatic PFC. Our single center study suggests that a trans-gastric approach is associated with improved clinical outcomes. The endoscopic approach is determined by the PFC location, the patient's anatomy, and the endoscopist's preference. Larger prospective studies that can account for the aforementioned variables are needed to validate these findings.2836_A Figure 1. Baseline Characteristics of PFC Cohort2836_B Figure 2. Analysis of Variance Between Variables and Mean Size Reduction of PFC (in cm)2836_C Figure 3. Simple Regression Analysis with Change in PFC Size (in cm)