Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Gastrointest Surg. 2011 Nov;15(11):2080-8. doi: 10.1007/s11605-011-1621-8. Epub 2011 Jul 23.
Endoscopy is a minimally invasive technique for the drainage of peripancreatic fluid collections. This study evaluated the clinical outcomes and predictors of treatment success in consecutive patients undergoing endoscopic transmural drainage of peripancreatic fluid collections.
This is a retrospective study of patients who underwent endoscopic drainage of peripancreatic fluid collections over 7 years. Prior to drainage, an ERCP was attempted for stent placement in all patients with a pancreatic duct leak. Drainages were performed using conventional endoscopy or endoscopic ultrasound. Transmural stents and/or drainage catheters were deployed and endoscopic necrosectomy was undertaken when required. Data on clinical outcomes and complications were collected prospectively.
A total of 211 patients underwent drainage of peripancreatic fluid collections that was classified as pseudocyst in 45%, abscess in 28%, and necrosis in 27%. Mean diameter of the fluid collection was 100.6 mm, and 34.5% of patients had pancreatic duct stent placement. Median duration of follow-up was 356 days. Treatment success was 85.3% and was higher for pseudocyst and abscess compared to necrosis (93.5% vs. 63.2%, p < 0.0001). Complications were encountered in 17 patients (8.5%) and was higher for drainage of necrosis than pseudocyst or abscess (15.8% vs. 5.2%, p = 0.02). Treatment success was more likely for patients with pseudocyst or abscess than necrosis (adjusted OR = 7.6, 95% CI [2.9, 20.1], p < 0.0001) when adjusted for serum albumin and white cell count, type of endoscopic modality or accessory used, pancreatic duct stenting, luminal compression, size and location of fluid collection.
Endoscopic therapy is a highly effective technique for the management of patients with non-necrotic peripancreatic fluid collections.
内镜检查是一种用于引流胰周积液的微创技术。本研究评估了连续接受内镜经壁引流胰周积液的患者的临床结局和治疗成功的预测因素。
这是一项回顾性研究，纳入了 7 年内接受内镜引流胰周积液的患者。在引流前，所有胰管漏患者均尝试进行 ERCP 以放置支架。通过常规内镜或内镜超声进行引流。当需要时，放置经壁支架和/或引流导管，并进行内镜坏死组织清除术。前瞻性收集临床结局和并发症数据。
共 211 例患者接受了胰周积液引流，其中假性囊肿占 45%，脓肿占 28%，坏死组织占 27%。积液的平均直径为 100.6mm，34.5%的患者行胰管支架置入。中位随访时间为 356 天。治疗成功率为 85.3%，假性囊肿和脓肿的成功率高于坏死组织（93.5%比 63.2%，p < 0.0001）。17 例（8.5%）患者发生并发症，坏死组织引流的并发症发生率高于假性囊肿或脓肿（15.8%比 5.2%，p = 0.02）。调整血清白蛋白和白细胞计数、内镜方式或辅助器械类型、胰管支架置入、管腔压迫、积液大小和位置后，与坏死组织相比，假性囊肿或脓肿患者的治疗成功率更高（调整后的 OR = 7.6，95%CI [2.9，20.1]，p < 0.0001）。
内镜治疗是治疗非坏死性胰周积液患者的一种非常有效的技术。
