Natural Orifice Translumenal Endoscopic Drainage for Pancreatic Abscesses

INTRODUCTION: Endoscopic pseudocyst drainage is well documented, but few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis and/or peritonitis. We report the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses. METHODS: We reviewed consecutively treated patients (1994-2007). Approaches alone or in combination were: (1) transmural (transgastric or transduodenal), and (2) transpapillary. Criteria for abscesses were two or more of these: fever, abdominal pain, elevated WBC, and positive fluid cultures. RESULTS: Patients (n=35) had a mean age of 49 years (19 men/16 women). Etiologies were idiopathic 37%, gallstone 32%, alcohol 20%, and divisum 11%. Presenting signs were abdominal pain 80%, positive cultures 69%, fever 57%, elevated WBC 51% and nausea/vomiting 39%. Mean follow up was 15 months with a complication rate of 5%. No one died. Approaches (left columns) and outcomes (right columns) are as follows:CONCLUSION: Translumenal endoscopic surgery for pancreatic abscess is feasible and effective. It is an alternative to surgery that can now be considered a primary treatment option for pancreatic abscesses.

Session: Podium Presentation

Program Number: S033

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