EUS-guided drainage is an effective treatment for the majority of symptomatic
peripancreatic fluid collections
H.T. Künzli1, M.G.H. van Oijen1, R. Timmer2 , M.P. Schwartz3, B.J. Witteman4, B.L. Weusten2 , P.D.
Siersema1, F.P. Vleggaar1
1
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 2Departments of
Gastroenterology St. Antonius Hospital Nieuwegein , 3Meander Medical Center Amersfoort , 4Gelderse
Vallei Hospital Ede, the Netherlands
Endoscopic drainage is a well accepted treatment modality for symptomatic peripancreatic fluid
collections (PFC). Although some results on conventional or EUS-assisted PFC-drainage are available,
data on the efficacy and safety of EUS-guided drainage performed in large patient cohorts are scarce and
techniques used for drainage heterogeneous.
To evaluate clinical success and complication rate of EUS-guided drainage of PFCs and to identify
prognostic factors for complications and recurrence of PFCs.
Consecutive patients undergoing EUS-guided drainage of a PFC in the period 2004-2011 were included.
Patient characteristics, drainage techniques and follow up data were obtained by chart review. Technical
success was defined as the ability to enter and drain a PFC by placement of a transmural plastic double
pigtail stent, while clinical success was defined as complete resolution of a PFC on follow-up CT.
Procedure related mortality was defined as patients dying within 1 month after drainage as a consequence
of the drainage procedure.
Hundred-eight patients (56% males, mean age 55 (SD 14) years) underwent EUS-guided drainage of a
symptomatic PFC. Indications for drainage included abdominal pain (n=29), fever/sepsis (n=52),
dyspepsia/jaundice due to obstruction of the biliary/GI-tract (n=21) or other (n=3). Prophylactic
antibiotics were administered in 70/108 (71%) patients. The PFCs were drained through the stomach,
duodenum or distal esophagus in 102, 4 and 2 cases, respectively. The procedure was technically
successful in 105/108 (97%) of patients and a median of 2 (range 1-3) 7F or 10F pigtails were placed.
Drainage was not successful in 2 patients due to perforation of either the PFC or stomach wall. The PFC
collapsed in 1 patient before a pigtail could be placed. Following EUS-guided drainage, 33 patients (31%)
underwent 93 endoscopic transluminal necrosectomies (median 3 (range 1-9)). Clinical success was
observed in 87/104 (84%) patients after a median follow up of 53 (IQR 21-130) weeks, while PFC
recurrence was seen in 15/83 (18%) patients. Complications occurred in 21/105 (20%) patients, i.e.
secondary infection in 11, bleeding in 5, perforation in 4 and both infection and bleeding in 1 patient. No
procedure-related mortality was seen. Patients on prophylactic antibiotics had a significantly lower
complication rate (16%) than those not receiving antibiotics (37%, p=0.03).
Conclusions: EUS-guided drainage of PFCs is effective in the majority of patients. Although the
complication rate of the procedure is fair (20%), these did not result into mortality. Prophylactic
antibiotics may reduce the complication rate of EUS-guided drainage.