| ?Backgrouds? Pancreatic fluid collections(PFC)is a complication that occurs following acute or chronic pancreatitis,trauma,surgery,or tumor,including pancreatic pseudocyst(PPC)and walled-off necrosis(WON).Asymptomatic patients generally have small fluid collections that may spontaneously resolve.When the collection is large,gradually becomes larger,or induces symptoms or complications,it is necessary to drainage.Historically,surgery has been the main treatment method,which can result in large trauma,high incidence of complications,and long hospital stays.Recently,with the development of minimally invasive techniques,percutaneous drainage(PCD)and endoscopic-guided transmutral drainage(EUS-GTD)have achieved better efficacy.Therefore,these methods have been widely used in the treatment of PFC.However,only four studies compared the efficacy of PCD and endoscopic drainage in PFC patients,and the results were different.Among them,Azeem et al.and Kwon et al.included PFC patients following partial pancreatectomy.Akshintala et al.compared the efficacy of endoscopic drainage and PCD in symptomatic PPC patients.Keane et al.compared the efficacy of endoscopic drainage and PCD in symptomatic PFC patients,and endoscopic drainage in these studies included conventional endoscopic-guided drainage and EUS-GTD.But so far,there is no study which directly compared the clinical outcomes of PCD and EUS-GTD in PFC patients.?Objective? To compare the efficacy and safety of PCD and EUS-GTD in the management of PFC,and provide references for clinicans to make decision.?Methods? 1.To collect the clinical data of PFC who underwent PCD or EUS-GTD between January 2010 and July 2017 in our Hospital.The subjects were selected according to the inclusion and exclusion criteria.To compare technical success rate,symptomatic resolution rate,short-term(1 month after the operation)and long-term(6 months after the operation)radiologic remission rate,complication rate,recurrence rate,re-intervention rate,surgical intervention rate and length of hospital stay between PCD and EUS-GTD groups in PFC patients in this retrospective study.And analyze treatment measures for occurring complication or recurrence in both groups.Non-parametric test,chi-square test and Fisher exact test were used for statistical analysis.2.To compare the clinical outcomes of PCD and EUS-GTD in the complicated PFC patients,and find the best treatment for those patients.3.To compare the efficacy and safety PCD in WON and PPC patients who underwent PCD.4.To compare the efficacy and safety in WON and PPC patients who underwent EUS-GTD.5.To compare of efficacy and safety of PCD and EUS-GTD in PPC patients,and efficacy and safety of PCD and EUS-GTD in WON patients.?Results? 1.Totally,407 patients were screened.Accorind to the inclusion and exclusion criteria,115 cases were operated by PCD or EUS-GTD,and 112 patients(97.4%)were technically successful.Among them,39 patients underwent PCD and 73 patients underwent EUS-GTD.The technical success rate of the PCD and EUS group was 100%(39/39)and 96.1%(73/76),respectively,no statistically significant difference between the groups(P>0.05).There were no differences in terms of symptomatic resolution(87.2% vs 79.5%),short-term radiographic remission(77.1% vs 87.7%),long-term radiographic remission(81.5% vs 88.6%),complication(17.9% vs 28.8%),recurrence(15.0% vs 13.8%),re-intervention(10.3% vs 8.2%)and surgical intervention(5.1% vs 1.4%)between the PCD and EUS groups.But,patients who underwent PCD had longer length of median hospital stays than those who underwent EUS-GTD(14.0d vs 9.0 d,P<0.001).In addition,2 cases who initially underwent PCD received EUS-GTD due to recurrence,and 4 cases who initially underwent EUS-GTD received PCD due to complication(2 cases)and recurrence(2 cases).During follow-up,the above all 6 cases achieved symptomatic resolution and collection remission.2.For 89 cases complicated PFC patients,there were no differences in terms of symptomatic resolution(92.3% vs 79.4%),short-term radiographic remission(69.6% vs 87.3%),long-term radiographic remission(83.3% vs 90.0%),complication(23.1% vs 28.6%),recurrence(15.4% vs 12.0%)and re-intervention(11.5% vs 7.9%)between the PCD and EUS groups.But,patients who underwent PCD had longer length of median hospital stays than those who underwent EUS-GTD(15.0d vs 9.0d,P=0.002).All 3 cases(1 case in PCD group and 2 cases in EUS-GTD group)of postoperative hemorrhage were complicated by portal hypertension,and 2 cases in EUS-GTD group were initially inserted metal stent.3.There were no significant differences in symptomatic remission(76.9% vs 92.3%),short-term radiographic remission(60.0% vs 84.0%),long-term radiographic remission(66.7% vs 88.9%),recurrence(3.3% vs 24.0%),re-intervention(23.1% vs 3.8%)and length of median hospital stays(15.0d vs 13.5d)between PPC and WON groups who underwent PCD.However,the WON group had a higher complication rate than that of the PPC group(38.5% vs 7.7%,P=0.030).4.The PPC and WON groups who underwent EUS-GTD were comparable in terms of symptom remission(76.9% vs 80.9%),short-term radiographic remission(84.6% vs 89.4%),long-term radiographic remission(83.3% vs 92.3%),complication(30.8% vs 27.7),recurrence(10.5% vs 15.4%),re-intervention(16.0% vs 13.3%)and median length of hospital stay(9.0d vs 9.0d).5.For the PPC patients,there were no statistical differences in clinical success,complication,recurrence and re-intervention between both groups(P>0.05).However,patients who underwent PCD had longer length of median hospital stays than those who underwent EUS-GTD(13.5d vs 9.0d,P=0.012).For the WON patients,the comparative result of PCD and EUS-GTD was similar to that of the PPC group.?Conclusions? 1.Percutaneous drainage and endoscopic ultrasonography-guided drainage were effective and safe for the management of pancreatic fluid collections,and could be used in patients experiencing another method failure.However,hospital stays following percutaneous drainage were longer than following endoscopic ultrasonography-guided drainage.2.For the complicated pancreatic fluid collections(expect for patients complicated by portal hypertension),percutaneous drainage or endoscopic ultrasonography-guided drainage could be either applied.If fluid collections were complicated by portal hypertension,endoscopic utrasonography-guided plastic stent or nasocystic drainage is recommended.Endoscopic utrasonography-guided metal stent stent drainage or percutaneous drainage should be avoided.3.The clinical outcomes of pancreatic pseudocyst treated with percutaneous drainage were superior to those of walled-off necrosis.4.In the endoscopic ultrasonography group,the clinical outcomes of walled-off necrosis were comparable to those of pancreatic pseudocyst.5.For the pancreatic pseudocyst,the clinical outcomes of the percutaneous and endoscopic ultrasonography-guided drainages were comparable.However,patients in the percutaneous drainage had longer hospital stays than those in the endoscopic ultrasonography-guided drainage.For the walled-off necrosis,the comparative result of the percutaneous drainage and endoscopic ultrasonography-guided drainage was similar to those of the pancreatic pseudocyst. |
PDF Full Text Request