Table 3.
Comparison of clinical outcomes of endoscopic transmural drainage in walled-off pancreatic necrosis (WOPN) and pseudocysts
| WOPN Patients = 38 Procedures = 46 |
Pseudocyst Patients = 71 Procedures = 81 |
|
|---|---|---|
| Median age of patient, years (range) | 60 (22–84) | 51 (26–84) |
| Median maximal diameter—mm (range) | 119 (67–200) | 100 (40–250) |
| Portal hypertension % (n) | 58 % (22) | 44 % (31) |
| Reason for drainage % (n) | ||
| Pain | 24 % (11) | 43 % (35) |
| Increasing size + pain | 35 % (16) | 32 % (26) |
| Infection | 28 % (13) | 11 % (9) |
| Gastric outlet obstruction | 7 % (3) | 6 % (5) |
| Unknown | 7 % (3) | 7 % (6) |
| Sedation % (n) | ||
| Conscious sedation | 97 % (37) | 98 % (58) |
| General anaesthesia | 3 % (1) | 2 % (1) |
| Unknown | (8) | (23) |
| Approach % (n) | ||
| Transgastric | 98 % (42) | 91 % (60) |
| Transduodenal | 2 % (1) | 9 % (6) |
| Unknown | (3) | (15) |
| Cystotome used 5 (n) | 74 % (34) | 67 % (54) |
| Number of stents inserted % (n) | ||
| Plastic | ||
| 0 (Failed stent insertion/procedure abandoned) | 2 % (1) | 10 % (8) |
| 1 | 9 % (4) | 10 % (8) |
| 2 | 70 % (32) | 62 % (50) |
| 3 | 4 % (2) | 6 % (5) |
| 4 | 2 % (1) | 0 % (0) |
| Unknown | 7 % (3) | 10 % (8) |
| Fully covered self-expanding metal stents (FCSEMS) | 7 % (3) | 3 % (2) |
| Infection % (n) | ||
| Clinical signs of infection | 76 % (29/38) | 37 % (26/71) |
| Positive pancreatic fluid culture | 96 % (23/24) | 100 % (22/22) |
| Mixed growth | 46 % (11) | 50 % (11) |
| Streptococcus | 0 % (0) | 18 % (4) |
| Staphylococcus | 17 % (4) | 14 % (3) |
| E coli | 13 % (3) | 5 % (1) |
| Enterococcus | 8 % (2) | 5 % (1) |
| Other | 16 % (4) | 10 % (2) |
| Pancreatic fluid—co-infection | ||
| MRSA | 17 % (4) | 5 % (1) |
| Candida | 25 % (6) | 9 % (2) |
| Treatment success % (n) | 67 % (31/46) | 72 % (58/81) |
| Failed stent insertion/procedure abandoned | 2 % (1/46) | 10 % (8/81—2 cases required a further procedure) |
| Further procedure required | 37 % (14/38) | 24 % (17/71) |
| Adverse events % (n) | 7 % (3) | 12 % (10) |
| Stent migration | 2 % (1) | 4 % (3) |
| Haemorrhage—transfusion required | 0 % (0) | 3 % (2:1—acute, 1—delayed) |
| Pneumoperitoneum | 2 % (1) | 3 % (2) |
| Oesophageal perforation | 0 % (0) | 3 % (2) |
| Aspiration pneumonia | 2 % (1) | 0 % (0) |
| Pneumothorax | 0 % (0) | 1 % (1) |
| Residual PFC % (n) | 22 % (10/46) | 20 % (16/81) |
| Recurrent PFC % (n) | 9 % (4/46) | 5 % (4/81) |
| Number of drainage interventions required | ||
| Mean number of interventions (range) | 2.3 (1–7) | 1.5 (1–4) |
| Mean pre-ED (range) | 0.9 (0–6) | 0.3 (0–3) |
| Mean post-ED (range) | 0.5 (0–3) | 0.3 (0–3) |
| Surgical intervention ultimately required—% (n) | 5 % (2) | 3 % (2) |
| Length of stay: median number of days in hospital post-ED (range) | 4 (0–36) | 4 (0–63) |