Efficacy and safety of endoscopic drainage of peripancreatic fluid collections: a retrospective multicenter European study

Paraskevas Gkolfakis; Maria Chiara Petrone; Mario Tadic; Georgios Tziatzios; Ioannis Karoumpalis; Stefano Francesco Crinò; Antonio Facciorusso; Istvan Hritz; Dimitrios Kypraios; Athanasios D. Sioulas; Ilias Scotiniotis; Antonios Vezakis; Bank Keczer; Eleni Koukoulioti; Nicola Muscatiello; Konstantinos Triantafyllou; Andreas Polydorou; Ivica Grgurevic; Paolo Giorgio Arcidiacono; Ioannis S. Papanikolaou

Authors Paraskevas Gkolfakis, Maria Chiara Petrone, Mario Tadic, Georgios Tziatzios, Ioannis Karoumpalis, Stefano Francesco Crinò, Antonio Facciorusso, Istvan Hritz, Dimitrios Kypraios, Athanasios D. Sioulas, Ilias Scotiniotis, Antonios Vezakis, Bank Keczer, Eleni Koukoulioti, Nicola Muscatiello, Konstantinos Triantafyllou, Andreas Polydorou, Ivica Grgurevic, Paolo Giorgio Arcidiacono, Ioannis S. Papanikolaou.

Abstract

Background Endoscopic ultrasound (EUS)-guided transmural drainage allows treatment of symptomatic peripancreatic fluid collections (PFCs), with lumen-apposing metal stents (LAMS) and double pigtail plastic stents (DPPS) being the 2 most frequently used modalities.

Methods Consecutive patients undergoing PFC drainage in 10 European centers were retrospectively retrieved. Technical success (successful deployment), clinical success (satisfactory drainage), rate and type of early adverse events, drainage duration and complications on stent removal were evaluated.

Results A total of 128 patients—92 men (71.9%), age 57.2±11.9 years—underwent drainage, with pancreatic pseudocyst (PC) and walled-off necrosis (WON) in 92 (71.9%) and 36 (28.1%) patients, respectively. LAMS were used in 80 (62.5%) patients and DPPS in 48 (37.5%). Technical success was achieved in 124 (96.9%) of the cases, with no difference regarding either the type of stent (P>0.99) or PFC type (P=0.07). Clinical success was achieved in 119 (93%); PC had a better response than WON (91/92 vs. 28/36, P<0.001), but the type of stent did not affect the clinical success rate (P=0.29). Twenty patients (15.6%) had at least one early complication, with bleeding
being the most common (n=7/20, 35%). No difference was detected in complication rate per type of stent (P=0.61) or per PFC type (P=0.1). Drainage duration was significantly longer with DPPS compared to LAMS: 88 (70-112) vs. 35 (29-55.3) days, P<0.001.

Conclusions EUS-guided drainage of PFCs achieves high percentages of technical and clinical success. Drainage using LAMS is of shorter duration, but the complication rate is similar between the 2 modalities.

Keywords Peripancreatic fluid collection, drainage, stent, endoscopic ultrasound

Ann Gastroenterol 2022; 35 (6): 654-662