Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts

A large multicenter study

Dennis Yang, Sunil Amin, Susana Gonzalez, Daniel Mullady, Stephen Hasak, Srinivas Gaddam, Steven A. Edmundowicz, Mark A. Gromski, John M. Dewitt, Mohamad El Zein, Mouen Khashab, Andrew Y. Wang, Jonathan P. Gaspar, Dushant S. Uppal, Satish Nagula, Samir Kapadia, Jonathan M. Buscaglia, Juan Carlos Bucobo, Alex Schlachterman, Mihir S. Wagh & 22 others Peter V. Draganov, Min Kyu Jung, Tyler Stevens, John J. Vargo, Harshit S. Khara, Mustafa Huseini, David L. Diehl, Rajesh N. Keswani, Ryan Law, Srinadh Komanduri, Patrick S. Yachimski, Tomas Davee, Anoop Prabhu, Robert T. Lapp, Richard S. Kwon, Rabindra R. Watson, Adam J. Goodman, Natasha Chhabra, Wallace J. Wang, Petros Benias, David L. Carr-Locke, Christopher J. Dimaio

Research output: Contribution to journalArticle

Abstract

Background and Aims The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution. Methods This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression. Results A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P =.0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P =.23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P =.37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P =.61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P =.79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P =.03). Conclusions TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.

Original languageEnglish (US)
Pages (from-to)720-729
Number of pages10
JournalGastrointestinal Endoscopy
Volume83
Issue number4
DOIs
StatePublished - Apr 1 2016

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Pancreatic Pseudocyst
Multicenter Studies
Drainage

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts : A large multicenter study. / Yang, Dennis; Amin, Sunil; Gonzalez, Susana; Mullady, Daniel; Hasak, Stephen; Gaddam, Srinivas; Edmundowicz, Steven A.; Gromski, Mark A.; Dewitt, John M.; El Zein, Mohamad; Khashab, Mouen; Wang, Andrew Y.; Gaspar, Jonathan P.; Uppal, Dushant S.; Nagula, Satish; Kapadia, Samir; Buscaglia, Jonathan M.; Bucobo, Juan Carlos; Schlachterman, Alex; Wagh, Mihir S.; Draganov, Peter V.; Jung, Min Kyu; Stevens, Tyler; Vargo, John J.; Khara, Harshit S.; Huseini, Mustafa; Diehl, David L.; Keswani, Rajesh N.; Law, Ryan; Komanduri, Srinadh; Yachimski, Patrick S.; Davee, Tomas; Prabhu, Anoop; Lapp, Robert T.; Kwon, Richard S.; Watson, Rabindra R.; Goodman, Adam J.; Chhabra, Natasha; Wang, Wallace J.; Benias, Petros; Carr-Locke, David L.; Dimaio, Christopher J.

In: Gastrointestinal Endoscopy, Vol. 83, No. 4, 01.04.2016, p. 720-729.

Research output: Contribution to journalArticle

Yang, D, Amin, S, Gonzalez, S, Mullady, D, Hasak, S, Gaddam, S, Edmundowicz, SA, Gromski, MA, Dewitt, JM, El Zein, M, Khashab, M, Wang, AY, Gaspar, JP, Uppal, DS, Nagula, S, Kapadia, S, Buscaglia, JM, Bucobo, JC, Schlachterman, A, Wagh, MS, Draganov, PV, Jung, MK, Stevens, T, Vargo, JJ, Khara, HS, Huseini, M, Diehl, DL, Keswani, RN, Law, R, Komanduri, S, Yachimski, PS, Davee, T, Prabhu, A, Lapp, RT, Kwon, RS, Watson, RR, Goodman, AJ, Chhabra, N, Wang, WJ, Benias, P, Carr-Locke, DL & Dimaio, CJ 2016, 'Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: A large multicenter study', Gastrointestinal Endoscopy, vol. 83, no. 4, pp. 720-729. https://doi.org/10.1016/j.gie.2015.10.040
Yang, Dennis ; Amin, Sunil ; Gonzalez, Susana ; Mullady, Daniel ; Hasak, Stephen ; Gaddam, Srinivas ; Edmundowicz, Steven A. ; Gromski, Mark A. ; Dewitt, John M. ; El Zein, Mohamad ; Khashab, Mouen ; Wang, Andrew Y. ; Gaspar, Jonathan P. ; Uppal, Dushant S. ; Nagula, Satish ; Kapadia, Samir ; Buscaglia, Jonathan M. ; Bucobo, Juan Carlos ; Schlachterman, Alex ; Wagh, Mihir S. ; Draganov, Peter V. ; Jung, Min Kyu ; Stevens, Tyler ; Vargo, John J. ; Khara, Harshit S. ; Huseini, Mustafa ; Diehl, David L. ; Keswani, Rajesh N. ; Law, Ryan ; Komanduri, Srinadh ; Yachimski, Patrick S. ; Davee, Tomas ; Prabhu, Anoop ; Lapp, Robert T. ; Kwon, Richard S. ; Watson, Rabindra R. ; Goodman, Adam J. ; Chhabra, Natasha ; Wang, Wallace J. ; Benias, Petros ; Carr-Locke, David L. ; Dimaio, Christopher J. / Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts : A large multicenter study. In: Gastrointestinal Endoscopy. 2016 ; Vol. 83, No. 4. pp. 720-729.
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abstract = "Background and Aims The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution. Methods This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression. Results A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55{\%}) and CD in 79 (45{\%}) pseudocysts. Technical success was as follows: TMD, 92 (97{\%}) versus CD, 35 (44{\%}) (P =.0001). There was no difference in adverse events between the TMD (15{\%}) and CD (14{\%}) cohorts (P =.23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P =.37). There was no difference in LT symptomatic resolution (TMD, 69{\%} vs CD, 62{\%}; P =.61) or LT radiologic resolution (TMD, 71{\%} vs CD, 67{\%}; P =.79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95{\%} confidence interval, 0.02-0.8; P =.03). Conclusions TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.",
author = "Dennis Yang and Sunil Amin and Susana Gonzalez and Daniel Mullady and Stephen Hasak and Srinivas Gaddam and Edmundowicz, {Steven A.} and Gromski, {Mark A.} and Dewitt, {John M.} and {El Zein}, Mohamad and Mouen Khashab and Wang, {Andrew Y.} and Gaspar, {Jonathan P.} and Uppal, {Dushant S.} and Satish Nagula and Samir Kapadia and Buscaglia, {Jonathan M.} and Bucobo, {Juan Carlos} and Alex Schlachterman and Wagh, {Mihir S.} and Draganov, {Peter V.} and Jung, {Min Kyu} and Tyler Stevens and Vargo, {John J.} and Khara, {Harshit S.} and Mustafa Huseini and Diehl, {David L.} and Keswani, {Rajesh N.} and Ryan Law and Srinadh Komanduri and Yachimski, {Patrick S.} and Tomas Davee and Anoop Prabhu and Lapp, {Robert T.} and Kwon, {Richard S.} and Watson, {Rabindra R.} and Goodman, {Adam J.} and Natasha Chhabra and Wang, {Wallace J.} and Petros Benias and Carr-Locke, {David L.} and Dimaio, {Christopher J.}",
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TY - JOUR

T1 - Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts

T2 - A large multicenter study

AU - Yang, Dennis

AU - Amin, Sunil

AU - Gonzalez, Susana

AU - Mullady, Daniel

AU - Hasak, Stephen

AU - Gaddam, Srinivas

AU - Edmundowicz, Steven A.

AU - Gromski, Mark A.

AU - Dewitt, John M.

AU - El Zein, Mohamad

AU - Khashab, Mouen

AU - Wang, Andrew Y.

AU - Gaspar, Jonathan P.

AU - Uppal, Dushant S.

AU - Nagula, Satish

AU - Kapadia, Samir

AU - Buscaglia, Jonathan M.

AU - Bucobo, Juan Carlos

AU - Schlachterman, Alex

AU - Wagh, Mihir S.

AU - Draganov, Peter V.

AU - Jung, Min Kyu

AU - Stevens, Tyler

AU - Vargo, John J.

AU - Khara, Harshit S.

AU - Huseini, Mustafa

AU - Diehl, David L.

AU - Keswani, Rajesh N.

AU - Law, Ryan

AU - Komanduri, Srinadh

AU - Yachimski, Patrick S.

AU - Davee, Tomas

AU - Prabhu, Anoop

AU - Lapp, Robert T.

AU - Kwon, Richard S.

AU - Watson, Rabindra R.

AU - Goodman, Adam J.

AU - Chhabra, Natasha

AU - Wang, Wallace J.

AU - Benias, Petros

AU - Carr-Locke, David L.

AU - Dimaio, Christopher J.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background and Aims The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution. Methods This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression. Results A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P =.0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P =.23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P =.37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P =.61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P =.79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P =.03). Conclusions TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.

AB - Background and Aims The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution. Methods This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression. Results A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P =.0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P =.23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P =.37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P =.61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P =.79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P =.03). Conclusions TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.

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U2 - 10.1016/j.gie.2015.10.040

DO - 10.1016/j.gie.2015.10.040

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EP - 729

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

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