Transmural Entry into Pancreatic Fluid Collections Using a Dedicated Aspiration Needle without Endoscopic Ultrasound Guidance

Abstract

Purpose: Endoscopic drainage of pancreatic fluid collections (PFC) is increasingly being performed. A variety of techniques have been described to perform transmural entry, however, there is a lack of data on the technical success and safety of transmural entry using a single technique. We describe the largest experience in transmural entry of PFC's without EUS-guidance using a dedicated aspiration needle. Methods: All patients who underwent endoscopic transmural drainage of PFC from October 1998-May 2006 were identified from the endoscopy database. Data were abstracted from the endoscopic procedure report and the patient records and placed in a JMP drive. All drainages were performed without EUS guidance after visualization of an obvious intraluminal bulge using a dedicated large-bore aspiration needle (BAN-18, Cook Medical, Winston-Salem, NC). The transmural tract into the PFC was dilated using dilating balloons ranging from 6–20mm in diameter followed by subsequent placement of one-two 10-Fr double pigtail stents with or without nasocystic irrigation tubes. Successful entry was defined as entry allowing for placement of stents. Results: Table 1 summarizes the main results.Table 1: Results.1.No significant difference in the complication rate was observed when analyzed for the following variables: age, gender, balloon diameter, presence of endoscopic impression, drainage approach, size and type of fluid collection. Conclusions: Endoscopic transmural drainage of pancreatic fluid collections can be performed safely and effectively via the seldinger technique without endoscopic ultrasound guidance. This data will allow sample size calculations to be made if direct comparisons to this technique and others are undertaken.