A comparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts

摘要

Background Endoscopic drainage (ED) and percutaneous drainage (PD) have largely replaced surgical drainage as the initial approach for symptomatic pseudocysts. However, there are few studies comparing ED and PD. Objective To compare the outcomes of ED and PD for symptomatic pseudocysts. Design Retrospective cohort study. Setting Academic center. Patients Adult patients with symptomatic pseudocysts within ≤1 cm of the gastric or duodenal wall who underwent ED or PD between 1993 and 2011. Patients with walled-off pancreatic necrosis were excluded. Intervention ED or PD. Main Outcome Measurements Rates of technical success, procedural adverse events, clinical success, reinterventions, and failure. Other outcomes included the length of hospital stay and number of follow-up abdominal imaging studies. Results There were 81 patients, 41 who underwent ED and 40 who underwent PD, with no differences in age, sex, and comorbidity between the 2 groups. There were no differences in the rates of technical success (90.2% vs 97.5%; P =.36), adverse events (14.6% vs 15%; P =.96), and clinical success (70.7% vs 72.5%; P =.86) between ED and PD, respectively. Patients who underwent PD had higher rates of reintervention (42.5% vs 9.8%; P =.001), longer length of hospital stay (14.8 ± 14.4 vs 6.5 ± 6.7 days; P =.001), and median number [quartiles] of follow-up abdominal imaging studies (6 [3.25, 10] vs 4 [2.5, 6]; P =.02) compared with patients who underwent ED. Limitations Single center, retrospective study. Conclusion ED and PD have similar clinical success rates for symptomatic pseudocysts. However, PD is associated with significantly higher rates of reintervention, longer length of hospital stay, and increased number of follow-up abdominal imaging studies.