Document Detail

Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos).
MedLine Citation:
PMID:  18640677     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although prior studies evaluated the role of EUS and EGD for drainage of pancreatic pseudocysts, there are no randomized trials that compared the technical outcomes between both modalities. OBJECTIVE: To compare the rate of technical success between EUS and EGD for transmural drainage of pancreatic pseudocysts. STUDY DESIGN: A prospective randomized trial. SETTING: A tertiary-referral center. PATIENTS: Those with a history of pancreatitis and symptomatic pancreatic pseudocysts that measured greater than 4 cm in size who were referred for endoscopic transmural drainage. Patients with pancreatic abscess or necrosis were excluded. MAIN OUTCOME MEASUREMENTS: Technical success was defined as the ability to access and drain a pseudocyst by placement of transmural stents. Complications were assessed at 24 hours and at day 30. Treatment success was defined as the complete resolution or decrease in size of the pseudocyst to <or=2 cm on CT in association with clinical resolution of symptoms at 6 weeks of follow-up. RESULTS: Thirty patients were randomized to undergo pseudocyst drainage by EUS (n = 15) or EGD (n = 15) over a 6-month period. Of the 15 patients randomized to EUS, drainage was not undertaken in one, because an alternative diagnosis of biliary cystadenoma was established at EUS and was excluded (after randomization) from analysis. The mean age of the patients was 47 years; 62% were men (18/29). Except for their sex, there was no difference in patient or clinical characteristics between the 2 cohorts. Although all the patients (n = 14) randomized to an EUS underwent successful drainage (100%), the procedure was technically successful in only 5 of 15 patients (33%) randomized to an EGD (P < .001). All 10 patients who failed drainage by EGD underwent successful drainage of the pseudocyst on a crossover to EUS. There was no significant difference in the rates of treatment success between EUS and EGD after stenting, either by intention-to-treat (ITT) analysis (100% vs 87%; P = .48) or as-treated analysis (95.8% vs 80%; P = .32). Major procedure-related bleeding was encountered in 2 patients in whom drainage by EGD was attempted; one resulted in death and the other necessitated a blood transfusion. No significant difference was observed between EUS and EGD with regard to complications either by ITT (0% vs 13%; P = .48) or as-treated analyses (4% vs 20%; P = .32). Technical success was significantly greater for EUS than EGD, even after adjusting for luminal compression and sex (adjusted exact odds ratio 39.4; P = .001). LIMITATION: Short duration of follow-up. CONCLUSIONS: When available, EUS should be considered as the first-line treatment modality for endoscopic drainage of pancreatic pseudocysts given its high technical success rate.
Shyam Varadarajulu; John D Christein; Ashutosh Tamhane; Ernesto R Drelichman; C Mel Wilcox
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2008-07-21
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  68     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2009-05-05     Revised Date:  2010-02-23    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1102-11     Citation Subset:  IM    
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
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MeSH Terms
Drainage / methods*
Endoscopy, Digestive System*
Middle Aged
Pancreatic Pseudocyst / therapy*
Prospective Studies
Young Adult
Comment In:
Gastrointest Endosc. 2010 Feb;71(2):432; author reply 432-3   [PMID:  20152326 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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