Results

EUS-guided endoscopic drainage of peripancreatic collections was performed in a total of 35 patients over a three-year period. The mean age was 49.68 ± 12.90 years, with a range from 28 to 86 years. There was a slight female predominance, accounting for 51.4% (n = 18), while males represented 48.6% (n = 17).

Regarding the distribution by type of collection, pancreatic pseudocyst was the most frequent, representing 65.7% (n = 23) of cases, whereas WON accounted for 34.3% (n = 12) (Figures 1, 2).

Figure 1: Endoscopic ultrasound (EUS) view of a 10-cm pancreatic pseudocyst.(A) EUS view of a 10-cm pancreatic pseudocyst. (B) Drainage using a lumen-apposing metal stent (LAMS). (C) Endoscopic view of the interior of the cystic cavity. (D) Resolution of the cystic cavity four weeks after drainage.

Figure 2: Walled-off necrosis (WON).(A) Endoscopic ultrasound (EUS) view with the stent in situ. (B) Necrotic content drained into the gastric cavity.

Among patients with pancreatic pseudocysts, 13.0% (n = 3) presented with infection at the time of drainage, evidenced by the presence of purulent material and debris, without evidence of necrotic tissue.

Regarding stent type, the most commonly used was the double pigtail plastic stent, employed in 60.0% (n = 21) of cases, while lumen-apposing metal stents (LAMS) were used in 40.0% (n = 14). This distribution was mainly related to device availability at the time of the procedure rather than to differences in efficacy between stent types (Table 1).

Variable | n (%)
Collection type
Pseudocyst | 23 (65.7%)
WON | 12 (34.3%)
Pseudocyst infection
Yes | 3 (13.0%)
No | 20 (87.0)
Necrosectomy
Yes | 3 (8.6%)
No | 32 (91.4%)
Stent type
Double plastic pigtail | 21 (60.0%)
LAMS | 14 (40.0%)
Transmural drainage
Stomach | 34 (97.1%)
Duodenum | 1 (2.9%)

The mean stent indwelling time was 35.31 ± 9.58 days, with a minimum of 27 days and a maximum of 61 days. The mean post-procedural hospital stay was 3.5 days. Direct endoscopic necrosectomy was performed in 8.6% of cases (n = 3), corresponding to patients who did not show adequate clinical improvement after the initial transmural drainage.

From a technical standpoint, transmural drainage was predominantly performed via the stomach in 97.1% of cases (n = 34), whereas only one case (2.9%) was performed via the duodenum (Table 1, Figure 3).

Figure 3: Use of a double-pigtail plastic stent.(A) Transmural drainage into the duodenum. (B) Transmural gastric drainage.

Technical success of endoscopic management with stent placement was achieved in 100% of cases (n = 35), while recurrence of peripancreatic collections occurred in three patients, representing 8.6% (n = 3) of the cohort.

Complications were reported in only 5.8% of patients (n = 2), corresponding to one case of bleeding and one case of stent obstruction, each accounting for 2.9%. Both complications were successfully managed: bleeding with hemostasis using hemoclips, and stent obstruction through stent removal and lumen cleaning.

No cases of technical failure were recorded (0.0%), and there was no 30-day mortality (n = 0).