Autori: Seicean A., Stan-Iuga R., Badea R., Tantau M., Mocan T., Seicean R., Iancu C., Pascu O.
Editorial: J Gastrointestin Liver Diseas, 20 (1), p.39-45 , 2011.
Background: Endoscopic ultrasonography (EUS) is preferred for guiding drainage of pancreatic fluid collections,with a success rate exceeding 90% when fluoroscopy is used. When fluoroscopy cannot be used, drainage can still
be performed, but no data regarding the safety of such a procedure have yet been published. Aim: To establish the
safety of EUS-guided drainage without fluoroscopic control and to identify criteria for the selection of suitable patients. Methods: The pancreatic fluid collections considered suitable for EUS-guided drainage were >5 cm in diameter, symptomatic, without ductal communication. We attempted EUS-guided drainage of PC prospectively in 24 patients: 9 with abscesses and 15 with pseudocysts. Results: Drainage was successful in 20 cases (83.3%), with complete resolution after a median 18 months’ follow-up. EUS-guided drainage
failed in four patients (16.7%): one in the abscess group due to symptomatic pneumoperitoneum and three in the
pseudocyst group due to thick wall. Drainage failure was associated with a diameter <6 cm and wall thickness >2 mm
and was considered to be due to the sliding of the cystotome on the pseudocyst wall. During follow-up there was one procedure unrelated death (4.1%) and no pancreatic fluid collections relapses. Conclusions: Fluoroscopic control represents a helpful tool, but it is not always necessary for EUS-guided drainage of pancreatic fluid collections. EUS-guided drainage is possible, efficient and safe without fluoroscopy in selected pancreatic fluid collections with a diameter larger than 6 cm and a thin wall. Collections with
a thick wall should be drained under fluoroscopy or referred directly for surgery.
Cuvinte cheie: EUS drainage fluid collection, pseudocyst, abscesses, treatment, pancreas