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• W2016206770 abstract "Although surgery is the gold standard, recent trend favors endoscopy for the minimally invasive management of PFCs. Aim: Assess the recent trend in management of PFCs and identify factors impacting this trend. The endoscopy and surgical databases were queried for patients treated for symptomatic PFCs over 6-yrs (2004-2010). Inpatients were evaluated by both surgical and medical teams and outpatients by interdepartmental consultations. PFCs were categorized as pseudocysts (PP) or complex collections (CC) that included pancreatic abscess and walled-off pancreatic necrosis (WOPN). Surgery included cystogastrostomy +/− debridement and endoscopy (conventional transmural drainage [CTD] or EUS-guided drainage) included transluminal drainage with stents/catheters and necrosectomy if required. Endoscopic accessories used were constant throughout the study period except for a portable EUS processor from 2008 onwards to perform bedside drainages in acutely ill patients. Main outcome measure was to compare the trend in management of PFCs from 2004-2007 (group I) and from 2008-2010 (group II). A total of 285 PFC patients were treated: group I included 119 patients and group II 166. Group I: Of 119 patients, 29% (total=34: PP = 12, CC=22) were treated by surgery and 71% (total=85: PP=55, CC=30) by endoscopy. Of the 85 endoscopy patients, 42% were drained by CTD and 58% by EUS. Compared to surgery, the rate of treatment success was superior for endoscopy, 86% vs. 68%, p=0.02. Group II: Of 166 patients, 31% (total =51: PP = 0, CC=51) were treated by surgery and 69% (total=115: pseudocyst=48, CC=67) by endoscopy. Of the 115 endoscopy patients, 17% were drained by CTD and 83% by EUS. Rates of treatment success were not significantly different between endoscopy and surgery, 84% vs. 80%, p=0.53. Outcomes: When compared to group I, virtually all PP (82% vs.100%, p=0.001) and a higher proportion of CC (35% vs. 58%, p=0.002) in group II were managed by endoscopy. Although surgery was reserved exclusively for CC in group II, a majority of CC were still treated by endoscopy (43% vs. 57%). EUS was used more frequently for group II procedures than group I (83% vs. 58%, p=0.0001) of which 20% were performed at the patients bedside. PFCs not causing a luminal compression, i.e., those located in the body/tail region of the pancreas (adjusted OR=6.7, p< 0.0001) and measuring < 9cm in size (adjusted OR=6.8, p< 0.0001) were more likely to require EUS-guided drainage than CTD when adjusted for category of PFC. There has been a significant shift in trend, at our institution, in the management of PFCs with all pseudocysts and a majority of abscess and WOPN being treated by endoscopy. The ability to perform bedside EUS and access PFCs not causing a luminal compression have significantly expanded the role of endoscopy in PFC management." @default.
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• W2016206770 date "2011-04-01" @default.
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• W2016206770 title "Tu1400 Management of Pancreatic Fluid Collections (PFCs): A Changing of the Guard From Surgery to Endoscopy" @default.
• W2016206770 doi "https://doi.org/10.1016/j.gie.2011.03.892" @default.
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