Interventional ultrasound-guided procedures in pancreatic pseudocysts, abscesses and infected necroses - treatment algorithm in a large single-center study.

Abstract

UNLABELLED:

Through a time period of 5 years, all consecutive patients were documented in this prospective single centre observational clinical study to investigate feasibility and outcome of ultrasound(US)- and EUS-guided drainage of symptomatic non-infected pancreatic pseudocysts and abscesses as well as the endoscopic debridement of infected necroses.

RESULTS:

From 03 / 23 / 2002 to 12 / 31 / 2008, 147 patients (females:males = 49:98 [1:2.0]) with pseudocysts (n = 32), abscesses (n = 81) and necroses (n = 34) were enrolled in the study. Technical success rate in US-guided external and in EUS-guided transmural drainage was 100 % and 97.0 %, respectively, whereas that of transpapillary (ERP-guided) drainage was 92.1 %. While the complication rate in external drainage was 3.7 %, this rate in transmural and transpapillary drainage was 9.6 % and 0, respectively. Late complications (> 24 h) were observed in 6.4 % of patients after transpapillary drainage (external drainage, 5.6 %; transmural drainage, 19.1 %). Complications in 5 cases (bleeding, n = 3; perforation, n = 1; dislocation of the prosthesis with perforation of the terminal ileum, n = 1) needed to be approached surgically. After a mean follow-up period of 20.7 months, 20.9 months, and 19.4 months, the definitive therapeutic success rate was 96.2 % in average for the three diagnoses such as pseudocyst (96.9 %), abscess (97.5 %), and necrosis (94.1 %), respectively (recurrency rate, 15.4 % in average; overall mortality, 0.7 % but no intervention-related death).

CONCLUSION:

US- and endoscopy-based management of pancreatic lesions as reported is suitable and favorable also in daily clinical routine since it is a safe and efficacious approach in experienced hands.

• Authors: U Will, C Wanzar, R Gerlach, F Meyer
• Journal: Ultraschall in der Medizin (Stuttgart, Germany : 1980) (Ultraschall Med) Vol. 32 Issue 2 Pg. 176-83 (Apr 2011) ISSN: 1438-8782 [Electronic] Germany
• PMID: 21259182 (Publication Type: Comparative Study, Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Topics

• Abscess (diagnostic imaging, therapy)
• Adult
• Aged
• Algorithms
• Bacterial Infections (diagnostic imaging, therapy)
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects, methods)
• Drainage (adverse effects, methods)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Outcome and Process Assessment, Health Care
• Pancreatic Diseases (diagnostic imaging, therapy)
• Pancreatic Pseudocyst (diagnostic imaging, therapy)
• Pancreatitis, Acute Necrotizing (diagnostic imaging, therapy)
• Prospective Studies
• Ultrasonography, Interventional (adverse effects, methods)