Clinical Outcomes of Endoscopic Treatment for Peripancreatic Collections: An Observational Single-Center Study

Aims Peripancreatic fluid collections, commonly occurring after pancreatitis or pancreatic surgery, present significant clinical challenges. Endoscopic interventions, such as transluminal drainage and stenting, are effective treatment options, but further real-world data are needed to enhance understanding of outcomes and upgrade approaches. This study evaluates clinical outcomes, procedural success rates, and complications associated with endoscopic treatment, providing insights into patient management and procedural effectiveness.

Methods We conducted a retrospective observational study of patients with walled-off necrosis, pancreatic pseudocysts, or post-surgical collections treated with endoscopic drainage at our tertiary center from October 2021 to October 2024. Data included baseline patient characteristics, procedural details, and follow-up outcomes. All cases were analyzed as a group due to the small number of post-surgical patients, with secondary analysis to identify trends within this subgroup. Clinical resolution (symptom relief and fluid reduction) and procedural success were the primary outcomes. Secondary outcomes included complications, necrosectomy rates, hospitalization duration, stent types, and additional interventions.

Results In a cohort of 40 patients, pancreatitis was primarily alcohol-induced (57.5%), followed by gallstone-related (20%), idiopathic (5%), and post-ERCP/EUS (5%). Chronic pseudocysts were present in 37.5%, and 12.5% had post-surgical collections. Among those with walled-off necrosis (52.5%), the median time to drainage was 38 days, compared to 26 days for the post-surgical group. Indications for drainage included pain (60%), infection (40%), gastric outlet obstruction (30%), and jaundice (7.5%). Clinical resolution was achieved in 97.5% of patients, with a procedural success rate of 100%. Mean hospitalization duration was 6.3 days, and complications occurred in 20% (infection 15%, bleeding 2.5%, fluid leak 2.5%), managed conservatively with antibiotics (75%) or endoscopy (25%). Only 27.5% of patients required reinterventions due to stent obstruction or infections. The used stents were LAMS (82.5%) and plastic pigtail stents (17.5%), with one patient needing dual-gate drainage. Necrosectomy was performed in 25%, indicated by infection (40%, mean 9 days post-drainage) or stent obstruction (60%, mean 34.2 days). Following LAMS removal, 12 patients were left without a pigtail stent, resulting in a 25% recurrence rate, while those re-stented with a pigtail had a lower recurrence rate of 4.8%.

Conclusions Endoscopic treatment for peripancreatic collections in our tertiary center showed high success and clinical resolution with a manageable complication rate. Our data support endoscopic drainage as an effective first-line treatment. The need for necrosectomy, mainly due to infection or stent obstruction, emphasizes the importance of timely and personalized management. These results highlight the efficacy of endoscopic techniques and the need for tailored approaches to enhance outcomes and minimize reinterventions.

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Artikel online veröffentlicht:
27. März 2025