adult; aged; clinical effectiveness; controlled study; conventional transmural drainage; digestive tract endoscopy; duodenoscope; echoendoscope; endoscope; endoscopic transmural drainage; endoscopic ultrasound guided drainage; female; human; intermethod comparison; interventional ultrasonography; major clinical study; male; minimally invasive procedure; pancreas juice; pancreas necrosis; pancreas pseudocyst; prospective study; retrospective study; Review; tertiary care center; walled off pancreatic necrosis

Introduction: Walled-off pancreatic fluid collections, that are categorized as pancreatic pseudocysts and walled-off pancreatic necrosis (WOPN), arise as complications of acute or chronic pancreatitis. Endoscopic transmural drainage (ETD) is the current method of choice for the treatment of symptomatic walled-off pancreatic fluid collections. Methods: A retrospective analysis of prospectively collected data from patients who underwent an ETD at a tertiary referral gastroenterological center during a 6-year interval was performed. The technical, short- and long-term clinical success of ETD of walled-off pancreatic fluid collections was evaluated. The effectiveness of ETD performed with two types of endoscopes, with a duodenoscope (CTD - conventional transmural drainage) and with an echoendoscope (EUD - endoscopic ultrasound-guided drainage), was also compared. The choice of technique was at the discretion of the endoscopist performing the procedure. Results: In a cohort of 54 patients with a symptomatic pseudocyst or WOPN, the overall technical success rate of ETD was 94.4%, and this did not differ between EUD (100%) and CTD (88.6%) when the appropriate technique was selected (p = 0.104). Complications occurred in 31.5% of the patients, with no difference found between CTD and EUD (38.5 vs. 25%; p = 0.382). Clinical success persisted 3 months after stent insertion in 92.5% of patients with initial technical success of ETD and 6 months after stent extraction in 88.6% of the patients with clinical success 3 months after stent insertion. No difference was observed between EUD and CTD (3 months after stent insertion: 90.5 vs. 94.8%; p = 1.0; 6 months after stent extraction: 100 vs. 77.8%; p = 0.104). Of 51 patients with initial technical success, the therapeutic effect 6 months after stent extraction was 62.7%. Conclusion: In a cohort of 54 patients, the technical success, short-term and long-term clinical success of ETD of walled-off pancreatic fluid collections was 94.