| BackgroundPancreatic fluid collections refer to the abnormal collections of fluid in or around the pancreas parenchyma that occur after acute pancreatitis,chronic pancreatitis,pancreatic tumor,surgery,and pancreatic trauma.The 2012 Atlanta Classification Criteria revised the term pancreatic fluid collections into a new classification system,namely acute peripancreatic fluid collection,acute necrotic collection,pancreatic pseudocyst,and walled-off necrosis.Among them,pancreatic pseudocyst generally forms four weeks after the onset of interstitial edematous pancreatitis.It has a clear wall of non-epithelialized inflammatory fibrous tissue,rich in pancreatic amylase,free of fat and necrotic solid debris,and located only in the peripancreatic tissue.Pancreatic walled-off necrosis is an encapsulated effusion that develops four weeks after the onset of acute necrotizing pancreatitis.It has a clear capsule wall enclosing liquid and solid necrotic material,which may be located in the pancreas and/or peripancreatic tissues.When pancreatic inflammation subsides,some of the pancreatic fluid collections can be absorbed on its own.However,large and complex pancreatic pseudocyst with obvious clinical symptoms,such as infection,hemorrhage,pyloric or biliary obstruction,should be treated aggressively.The above indications also apply to pancreatic walled-off necrosis that cannot be absorbed spontaneously.Clinically,endoscopic drainage and surgical drainage are common methods for treating pancreatic fluid collections.Endoscopic trans-gastric fenestration is an effective endoscopic treatment for pancreatic fluid collections.At present,there is no relevant study at home and abroad to compare the efficacy of endoscopic trans-gastric fenestration and surgical drainage in the treatment of pancreatic fluid collections.ObjectiveTo explore and compare the clinical efficacy of endoscopic trans-gastric fenestration and surgical drainage in the treatment of pancreatic fluid collections.Materials and MethodsA total of 67 patients with pancreatic fluid collections who underwent endoscopic trans-gastric fenestration and surgical drainage in the First Affiliated Hospital of Zhengzhou University from March 2016 to June 2021 were retrospectively included.The general baseline data(gender,age,etiology,maximum diameter of pancreatic fluid collections,lesion location of pancreatic fluid collections,first-episode clinical manifestations)and clinically relevant indicators(technical success,clinical success,adverse events,recurrence,reintervention,operation time,postoperative fasting time and length of postoperative hospitalization)were collected from 67 patients.According to the two different drainage methods of endoscopic trans-gastric fenestration and surgical operation,67 patients were included in the endoscopic group and the surgical group,respectively.To compare general baseline characteristics and clinically relevant indicators such as technical success rate,clinical success rate,adverse event rate,recurrence rate,reintervention rate,median operative time,median postoperative fasting time and median length of postoperative hospitalization between endoscopic and surgical groups,and then to evaluate the efficacy of endoscopic trans-gastric fenestration and surgical drainage in the treatment of pancreatic fluid collections.In order to analyze the therapeutic effects of different types of pancreatic fluid collections,this study further compared the above clinically relevant indicators of pancreatic pseudocyst and pancreatic walled-off necrosis between the two drainage methods.SPSS 26.0 statistical software was used for statistical analysis,and P<0.05 indicated that the difference was statistically significant.ResultsA total of 67 patients with pancreatic fluid collections were collected in this study,including 34 in the endoscopic group and 33 in the surgical group.There were no significant differences between the two groups in gender(P=0.383),age(P=0.091),etiology(P=0.485),mean maximum diameter of pancreatic fluid collections(P=0.294)and lesion location of pancreatic fluid collections(P=0.529).In the comparison of clinically relevant indicators,the technical success rate(100%vs 100%)and clinical success rate(100%vs 97.0%,P=0.493)of the endoscopic group and the surgical group were comparable.The reintervention rate in the endoscopic group was higher than that in the surgical group(23.5%vs 0.0%,P=0.005);however,the incidence of adverse events was lower than that in the surgical group(29.4%vs 57.6%,P=0.02),and the median operative time[40.0(24.8,81.5)vs 170.0(131.5,183.0),P<0,001],median postoperative fasting time[2.0(1.0,4.3)vs 6.0(4.5,7.0),P<0.001]and median length of postoperative hospitalization[7.0(4.8,12.3)vs 13.0(9.5,15.5),P<0.001]was shorter than that of the surgical group,and the differences were statistically significant.In terms of recurrence rate,there was no significant difference between the endoscopic group and the surgical group(0.0%vs 12.1%,P=0.053).Subgroup analysis showed that the clinical success rate(100%vs 100%),incidence of adverse events(11.1%vs 15.4%,P=1.000),recurrence rate(0.0%vs 0.0%)cand reintervention rate(0.0%vs 0.0%)in patients with pancreatic pseudocyst drainage were comparable to those in the surgical group.However,in the endoscopic group,the median operation time[43.0(27.0,92.0)vs 155(125.5,178.0),P<0.001],the median postoperative fasting time[1.0(0.6,2.5)vs 5.0(3.5,7.0),P=0.003]and the median length of postoperative hospitalization[4.0(3.5,6.0)vs 11.0(10.0,13.5),P=0.002]were shorter than those in the surgical group,and the difference was statistically significant.In patients with pancreatic walled-off necrosis drainage,the clinical success rate in the endoscopic group was comparable to that in the surgical group(100%vs 95.0%,P=0.444),and the reintervention rate was higher than that in the surgical group(28.6%vs 0.0%,P=0.006).But for the incidence of adverse events(36.0%vs 85.0%,P=0.001),recurrence rate(0.0%vs 20.0%,P=0.033),median operation time[40.0(23.0,78.5)vs 170.5(150.8,192.5),P<0.001]and median postoperative fasting time[3.0(1.0,6.0)vs 6.0(5.33 7.8),P=0.02]in the endoscopic group was lower than the surgical group,with statistically significant differences.In terms of median length of postoperative hospitalization,there was no significant difference between the endoscopic group and the surgical group[10.0(6.5,13.0)vs 14.0(8.5,17.8),P=0.06].ConclusionsBoth endoscopic trans-gastric fenestration and surgery are effective in treating pancreatic fluid collections.However,compared with surgery,endoscopic trans-gastric fenestration drainage is a less invasive,safer and scarless drainage strategy for both the overall efficacy of pancreatic fluid collections and the treatment of pancreatic pseudocyst and walled-off necrosis. |
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