Endoscopic transmural drainage of pancreatic fluid collections (PFCs) is a minimally invasive and effective treatment modality for collections adjacent to the stomach or duodenum. However, when the location of the fluid collection cannot be seen endoscopically, or when collateral blood vessels are present, imaging guidance is required. Limited availability of endoscopic ultrasound (EUS)-guided drainage in many tertiary centres worldwide, including North America, continues to prohibit widespread access to this technique. An alternative, image-guided approach is required to allow safe endoscopic drainage of PFCs. 

We present our novel technique, performed in two separate stages. The first stage involves percutaneous insertion of a transgastric drain into the PFC under CT-guidance by interventional radiology (IR). The second stage performed in the endoscopy suite under endoscopic- and fluoroscopic-guidance. With direct endoscopic visualization, the posterior gastrostomy is cannulated and a guidewire delivered into the collection. The posterior gastrotomy is then serially balloon dilated and double pigtail plastic stents deployed. The anterior gastrotomy closes spontaneously.

A retrospective chart review was conducted for all patients at our centre who underwent IR-assisted endoscopic transgastric PFC drainage over a 10-year period 2007 and 2017. All patients had successful resolution of their PFCs on follow-up cross-sectional imaging, and were pain-free. Mean length of follow-up was 14 months (range 2-29 months). Complications included bleeding, pneumothorax and pneumoperitoneum. Complication rates were comparable with reported series in the literature using EUS-guided approaches.

IR-assisted endoscopic transgastric drainage of PFCs is technically feasible and safe. It provides an image-guided alternative to EUS-assisted drainage, with a comparable safety profile and favourable clinical outcomes.

Interventional Radiology-Assisted Endoscopic Transmural Drainage of Pancreatic Fluid Collections – An Image-Guided Alternative to EUS-Drainage.