Endoscopic Transgastric Drainage of Liquid Congestions and Post-Necrotic Cysts in Acute Pancreatitis
Aim. To develop methods of transgastric endoscopic drainage of liquid congestions and post-necrotic cysts in pancreatic necrosis and to estimate results of treatment. Material and Methods. Drainage of post-necrotic cysts and liquid congestions has been carried out in 60 patients. 34 patients underwent external drainage, 26 patients had EUS-assisted endoscopic transgastric drainage. Stages of postnecrotic cysts formation have been studied in 40 patients. Technique of endoscopic drainage included detection of cyst location relatively to gastric lumen using endosonography. The shortest trajectory between gastric lumen and cyst in avascular zone was chosen to apply cystogastroanastomosis. EUS-assisted cystogastrostomy was performed in 15 patients, in 5 cases cystogastrostomy was supplemented by stenting; 9 patients underwent transgastric puncture of cysts and liquid congestions, 5 of them had necrsequesterectomy. Results. External drainage was associated with external pancreatic fistula in 7 (18.9%) patients. External pancreatic fistula accompanied by hard-healing wound in the area of postoperative scar was observed in 3 (8%) patients. One patient (2.7%) suffered from external biliary fistula, 1 patient died due to multiple organ failure. There were no deaths after transgastric drainage. Conclusion. Transgastric drainage of post-necrotic cysts was not accompanied by deaths. If sequesters are present sanation of the cyst's cavity and stenting are necessary.