Interventional Ultrasound-Guided Procedures in Pancreatic Pseudocysts, Abscesses and Infected Necroses – Treatment Algorithm in a Large Single-Center Study

Zusammenfassung

Über einen Zeitraum von 5 Jahren wurden alle konsekutiven Patienten in dieser prospektiven „Single-center”-Observationsstudie dokumentiert, um Machbarkeit und „Outcome” der Ultraschall(US)- und EUS-geführten Drainage von symptomatischen nicht infizierten Pankreaspseudozysten und -abszessen als auch des endoskopischen Debridements infizierter Pankreasnekrosen zu untersuchen. Ergebnisse: Vom 23.3.2002 – 31.12.2008 wurden 147 Patienten (Frauen/Männer = 49 / 98 [1:2,0]) mit Pseudozysten (n = 32), Abszessen (n = 81) und Nekrosen (n = 34) registriert. Die technische Erfolgsrate bei der US-gestützten externen und der EUS-geführten transmuralen Drainage war 100 bzw. 97 % (transpapilläre [ERP-gestützte] Drainage: 92,1 %). Während die Komplikationsrate bei der externen Drainage 3,7 % ausmachte, lag diese Rate bei der transmuralen/transpapillären Drainage bei 9,6 %/ 0. Späte Komplikationen (> 24 h) wurden bei 6,4 % der Patienten nach transpapillärer Drainage beobachtet (externe/transmurale Drainage: 5,6 / 19,1 %). Komplikationen in 5 Fällen (Blutung: n = 3; Perforation: n = 1; Prothesendislolation mit Perforation des terminalen Ileums: n = 1) waren offen-chirurgisch zu versorgen. Nach einem mittleren Follow-up-Zeitraum von 20,7, 20,9 bzw. 19,4 Monaten wurde die definitive therapeutische Erfolgsrate mit durchschnittlich 96,2 % für die Pseudozyste (96,9 %), Abszess (97,5 %) und Nekrose (94,1 %) ermittelt (mittlere Rezidivrate: 15,4 %; Gesamtmortalität: 0,7 %, jedoch ohne interventionsbezogenen Todesfall). Schlussfolgerung: Das US- und Endoskopie-gestützte Management der aufgeführten Pankreasläsionen ist machbar und geeignet (auch in der täglichen Routine), da es als sicher und effektiv in erfahrener Hand anzusehen ist.

Abstract

Through a time period of 5 years, all consecutive patients were documented in this prospective single centre observational clinical study to investigate feasibility and outcome of ultrasound(US)- and EUS-guided drainage of symptomatic non-infected pancreatic pseudocysts and abscesses as well as the endoscopic debridement of infected necroses. Results: From 03 / 23 / 2002 to 12 / 31 / 2008, 147 patients (females:males = 49:98 [1:2.0]) with pseudocysts (n = 32), abscesses (n = 81) and necroses (n = 34) were enrolled in the study. Technical success rate in US-guided external and in EUS-guided transmural drainage was 100 % and 97.0 %, respectively, whereas that of transpapillary (ERP-guided) drainage was 92.1 %. While the complication rate in external drainage was 3.7 %, this rate in transmural and transpapillary drainage was 9.6 % and 0, respectively. Late complications (> 24 h) were observed in 6.4 % of patients after transpapillary drainage (external drainage, 5.6 %; transmural drainage, 19.1 %). Complications in 5 cases (bleeding, n = 3; perforation, n = 1; dislocation of the prosthesis with perforation of the terminal ileum, n = 1) needed to be approached surgically. After a mean follow-up period of 20.7 months, 20.9 months, and 19.4 months, the definitive therapeutic success rate was 96.2 % in average for the three diagnoses such as pseudocyst (96.9 %), abscess (97.5 %), and necrosis (94.1 %), respectively (recurrency rate, 15.4 % in average; overall mortality, 0.7 % but no intervention-related death). Conclusion: US- and endoscopy-based management of pancreatic lesions as reported is suitable and favorable also in daily clinical routine since it is a safe and efficacious approach in experienced hands.

pancreas - ultrasound - endoscopy - pancreatitis - abscess

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