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Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm

Clinical Endoscopy 2020년 53권 3호 p.355 ~ 360
Xu Ming Ming, Andalib Iman, Novikov Aleksey, Dawod Enad, Gabr Moamen, Gaidhane Monica, Tyberg Amy, Kahaleh Michel,
소속 상세정보
 ( Xu Ming Ming ) - Southern California Permanente Medical Group Division of Gastroenterology
 ( Andalib Iman ) - Rutgers University Robert Wood Johnson Medical School Division of Gastroenterology
 ( Novikov Aleksey ) - Thomas Jefferson University Hospital Division of Gastroenterology
 ( Dawod Enad ) - Weill Cornell Medical College Division of Gastroenterology
 ( Gabr Moamen ) - Weill Cornell Medical College Division of Gastroenterology
 ( Gaidhane Monica ) - Rutgers University Robert Wood Johnson Medical School Division of Gastroenterology
 ( Tyberg Amy ) - Rutgers University Robert Wood Johnson Medical School Division of Gastroenterology
 ( Kahaleh Michel ) - Rutgers University Robert Wood Johnson Medical School Division of Gastroenterology

Abstract


Background/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety.

Methods: Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm.

Results: A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069).

Conclusions: A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.

키워드

Endoscopic ultrasonography; Enteral feeding; Pancreatic pseudocyst; Pancreatitis; Stents

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