Current Utility of Transgastric Percutaneous Drainage for the Management of Pancreatitis-Related Retrogastric Walled-Off Necrotic Collections: A Prospective Observational Study

TL;DR

This study evaluates the effectiveness of transgastric drainage for treating pancreatic fluid collections, showing that successful internalization of drains improves recovery and reduces hospital stays.

Contribution

The study provides new evidence on the clinical benefits of transgastric percutaneous drainage and internalization for managing retrogastric walled-off pancreatic necrosis.

Findings

Transgastric drain placement achieved 93% technical success in 44 patients with pancreatic necrosis.

Internalization of transgastric drains was successful in 91% of 12 patients and correlated with shorter hospital stays.

Successful internalization reduced the need for additional procedures and improved recovery outcomes.

Abstract

Introduction

Pancreatic fluid collection (PFC) is one of the most frequent complications associated with acute pancreatitis. The route of drainage is guided by the size and site of collection. The present study aims to assess the clinical and technical success of transgastric percutaneous drainage (PCD) for managing retrogastric walled-off pancreatic necrosis (WOPN).

Materials and methods

A total of 44 patients with acute pancreatitis diagnosed with WOPN who underwent transgastric PCD with ultrasound or CT guidance as part of standard clinical management were included in the study. Patients were observed for improvement in clinical parameters, and treatment outcomes were noted in terms of technical success, clinical success, adverse events, need for additional procedures, hospital stay, and duration of placement of all drains. Data for the internalization of transgastric PCD was also observed in the study.

Results

Technical success during the drain placement was observed in 93% (n=41) of patients.Internalization of the transgastric drain was attempted in 12 patients and successful in 11 (91%). The median duration of hospital stay from the time of placement of the first PCD until discharge and the median duration of all PCDs placed were higher in patients where the transgastric drain was not internalized as compared to patients where the transgastric drain was internalized.

Conclusion

In WOPN, transgastric drain placement and successful internalization in any form help in the early resolution of peripancreatic and abdominal collections. It also reduces the time to percutaneous catheter removal, which in turn reduces the morbidity and decreases the need for additional interventions or surgery.

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