Background: Recently, pancreatic endotherapy is increasingly used even for the treatment of infectious complication of acute pancreatitis and successful endoscopic drainage of infected organized pancreatic nectrosis has been reported (Monkemuller et al, Gastrointest Endosc 1999). Although endoscopic internal drainage of pancreatic abscess has been successfully employed (Messmann, Endoscopy 1995), experience is limited and role of endoscopic drainage in the treatment of pancreatic abscess complicating acute pancreatitis is less well defined. Aim: To determine feasibility, effectiveness and safety of endoscopic drainage for the treatment of pacreatic abscess. Methods: In 6 patients (3M, 3F, mean age 56.1, range 49-67), 8 pancreatic abscesses compressing gut lumen (duodenal compression in 3 cases, stomach compression in 1 case, both duodenum and stomach compressing in 2 cases, mean size 5.3×6.8 cm) were drained endoscopically by means of endoscopic fistulization and subsequent stent(s) placement. Endoscopic fistulization was performed through the gastroduodenal wall using needle-knife (HPC-2, Wilson-Cook Medical Co, NC). Single, 7-10 Fr, biliary stent (pigtail in 6, straight in 2) was placed into the abscess cavity after an aspirate was taken for bacterial culture and irrigation with sterile saline through the evacuated needle-knife sheath or cannulation cathter. In one patient with largest abscess with thick pus, a 7 Fr nasobiliary catheter was placed concurrently with the 10 Fr stent to improve drainage after dilation of fistulous tract using a 10 Fr biliary dilation catheter. Follow-up was done by contrast enhanced CT. Results: Endoscopic drainage with endoscopic fistulization and placement of stent across the gastro-duodenal wall into the abscess cavity was successful in all cases. The mean duration of stent placement was 32.3 days (range 14-42). Complete drainge was achieved in 7 of 8 abscess cavities (87.5%). The complication was 1 case of bleeding (12.5%) requiring surgery which occurred during the repeated attempt of endoscopic transgastric drainage due to incomplete drainage. There was no mortality. Conclusion: These results suggest that endoscopic drainage with endoscopic fistulization followed by transgastro-duodenal stenting is a feasible, effective, and relatively safe non-surgical therapy in selective patients with pancreatic abscess compressing gastro-duodenal lumen. Background: Recently, pancreatic endotherapy is increasingly used even for the treatment of infectious complication of acute pancreatitis and successful endoscopic drainage of infected organized pancreatic nectrosis has been reported (Monkemuller et al, Gastrointest Endosc 1999). Although endoscopic internal drainage of pancreatic abscess has been successfully employed (Messmann, Endoscopy 1995), experience is limited and role of endoscopic drainage in the treatment of pancreatic abscess complicating acute pancreatitis is less well defined. Aim: To determine feasibility, effectiveness and safety of endoscopic drainage for the treatment of pacreatic abscess. Methods: In 6 patients (3M, 3F, mean age 56.1, range 49-67), 8 pancreatic abscesses compressing gut lumen (duodenal compression in 3 cases, stomach compression in 1 case, both duodenum and stomach compressing in 2 cases, mean size 5.3×6.8 cm) were drained endoscopically by means of endoscopic fistulization and subsequent stent(s) placement. Endoscopic fistulization was performed through the gastroduodenal wall using needle-knife (HPC-2, Wilson-Cook Medical Co, NC). Single, 7-10 Fr, biliary stent (pigtail in 6, straight in 2) was placed into the abscess cavity after an aspirate was taken for bacterial culture and irrigation with sterile saline through the evacuated needle-knife sheath or cannulation cathter. In one patient with largest abscess with thick pus, a 7 Fr nasobiliary catheter was placed concurrently with the 10 Fr stent to improve drainage after dilation of fistulous tract using a 10 Fr biliary dilation catheter. Follow-up was done by contrast enhanced CT. Results: Endoscopic drainage with endoscopic fistulization and placement of stent across the gastro-duodenal wall into the abscess cavity was successful in all cases. The mean duration of stent placement was 32.3 days (range 14-42). Complete drainge was achieved in 7 of 8 abscess cavities (87.5%). The complication was 1 case of bleeding (12.5%) requiring surgery which occurred during the repeated attempt of endoscopic transgastric drainage due to incomplete drainage. There was no mortality. Conclusion: These results suggest that endoscopic drainage with endoscopic fistulization followed by transgastro-duodenal stenting is a feasible, effective, and relatively safe non-surgical therapy in selective patients with pancreatic abscess compressing gastro-duodenal lumen.
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