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• W2019465705 abstract "Background: While successful drainage of pancreatic fluid collections (PFCs) with endoscopy is well described, the optimal algorithm for the endoscopic management of organized pancreatic necrosis (OPN) remains unclear. Endoscopic options include peroral debridement and placement of a nasocystic drain (NCD). Objective: Compare the technical and clinical success of endoscopic drainage of PFCs with and without initial placement of a NCD. Methods: We performed a retrospective cohort analysis of patients referred for endoscopic drainage of PFCs ≥ 5cm between January, 2003 and August, 2008. All patients underwent computed tomography (CT) scan and endoscopic ultrasound (EUS) prior to drainage with placement of 1-3 10F double pigtail cystenterostomy stents after a tract was dilated with a 10-15mm dilation balloon. An 8.5F NCD was placed at the endoscopist's discretion. Analysis was performed based on the presence of a NCD during the initial drainage (NCD+). Primary outcomes were the rate of cyst superinfection requiring additional endoscopic or surgical therapy and clinical resolution, defined as resolution of symptoms and a follow-up CT revealing a fluid collection < 2cm without surgical intervention. We performed a subgroup analysis of patients who demonstrated debris on EUS. Results: 53 patients were identified, 8 (15.1%) of whom underwent NCD placement during the initial endoscopy (NCD+). Endoscopic drainage was technically successful in 50 (94.3%) but complicated by perforation requiring surgery in 3 (5.7%). We observed clinical resolution in 100% of NCD+ patients compared to 82.2% of NCD- patients (p=0.20). While PFC size, average balloon dilation and number of stents were comparable in both groups, NCD+ patients were more likely to have debris on CT (37.5% vs. 2.2%, p=0.0005) and EUS (87.5% vs. 42.2%, p<0.02) at the time of drainage. Despite these unfavorable characteristics, superinfection occurred in 12.5% of NCD+ patients vs. 28.9% of NCD- (p=0.33). Among 13 NCD- patients with superinfection, 6 were successfully managed with subsequent placement of a NCD, 5 required surgical debridement and 2 were successfully treated by increasing the number of cystgastrostomy stents. In 26 patients with debris on EUS (7 NCD+), the rate of superinfection was 14.3% vs. 42.1% in NCD- patients (p=0.19). Conclusion: At the time of initial endoscopic drainage, use of a NCD results in a low rate of superinfection, particularly among PFCs complicated by debris. NCDs also salvage some cases of superinfection complicating initial drainage. A prospective trial to evaluate whether an NCD may extend the criteria for endoscopic drainage of PFCs is warranted." @default.
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• W2019465705 date "2009-04-01" @default.
• W2019465705 modified "2023-10-17" @default.
• W2019465705 title "Endoscopic Treatment of Pancreatic Fluid Collections: Role for Debridement with a Nasocystic Drain At the Time of Initial Endoscopy" @default.
• W2019465705 doi "https://doi.org/10.1016/j.gie.2009.03.960" @default.
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