• Stefan Seewald, Tiing Leong Ang, Hugo Richter, Karl Yu Kim Teng, Yan Zhong, Stefan Groth, Salem Omar, and Nib Soehendra.
• Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland. stefan.seewald@gastrozentrum.ch
• Dig Endosc. 2012 Jan 1; 24 (1): 36-41.

AimsTo determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections.MethodsThe data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively.ResultsEndoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%).ConclusionsEndoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.© 2011 The Authors. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society.

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