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Endoskopie heute 2009; 22(4): 243-250
DOI: 10.1055/s-0029-1224746
Originalarbeit

© Georg Thieme Verlag Stuttgart ˙ New York

Endoskopische ultraschallgesteuerte versus konventionelle transmurale Pankreaspseudozystendränage: Ergebnisse einer prospektiven randomisierten Studie

Endoscopic Ultrasound-Guided Versus Conventional Transmural Drainage for Pancreatic Pseudocysts: A Prospective Randomized TrialD. H. Park1 , S. S. Lee1 , S.-H. Moon1 , S. Y. Choi1 , S. W. Jung1 , D. W. Seo1 , S. K. Lee1 , M.-H. Kim1
  • 1Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, South Korea
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Publication History

Publication Date:
04 January 2010 (online)

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Zusammenfassung

Hintergrund und Studienziele: Obwohl die durch endoskopischen Ultraschall (EUS) gesteuerte transmurale Dränage (EUD) gegenüber der konventionellen endoskopischen transmuralen Dränage (CTD) durch Endoskopie in vielen Zentren präferiert wird, ist die Überlegenheit dieses Vorgehens hinsichtlich der technischen Erfolgsrate und des klinischen Ergebnisses durch keine prospektive randomisierte Studie belegt. Wir führten eine solche prospektive randomisierte Studie durch, um den technischen Erfolg und das klinische Ergebnis von EUD und CTD bei der Behandlung von Pankreaspseudozysten zu ermitteln. Patienten und Methoden: Insgesamt wurden 60 konsekutive Patienten mit Pankreaspseudozysten in 2 Gruppen randomisiert, um entweder eine EUD (n = 31) oder CTD (n = 29) von Pank­reaspseudozysten durchzuführen. Die technische Erfolgsrate, Komplikationen, Kurz- und Langzeitresultate wurden prospektiv erfasst. Ergebnisse: Die technische Erfolgsrate war in ­einer Intention-to-treat-Analyse bei der EUD ­höher (94 %, 29 / 31) als bei der CTD (72 %, 21 / 29; p = 0,039). In den Fällen wo eine CTD misslang (n = 8), weil die Pseudozysten keine Vorwölbung zeigten, wurde ein Cross-over zur EUD durchgeführt, das in allen Fällen erfolgreich war. Komplikationen traten in 7 % bei der EUD- und in 10 % in der CTD-Gruppe (p = 0,67) auf. Während des Kurzzeit-Follow-ups wurde mit der EUD das Verschwinden der Pseudozyste in 97 % (28 / 29) und in 91 % (19 / 21) in der CTD-Gruppe (p = 0,565) erreicht. Langezeitresultate wurden auf der Basis einer Per-Protokoll-Ana­lyse ermittelt. Sie zeigten keinen Unterschied im klinischen Ergebnis zwischen EUD (89 %, 33 / 37) und CTD (86 %, 18 / 21, p = 0,696). Schlussfolgerungen: Wir konnten zeigen, dass sowohl die EUD als auch die CTD die primäre Methode der endoskopischen transmuralen Dränage von sich vorwölbenden Pseudozysten sein können. Die EUD sollte bei sich nicht vorwölbenden Pseudozysten präferiert werden.

Abstract

Background and study aims: Although endoscopic ultrasound (EUS)-guided transmural drainage (EUD) is preferred over conventional transmural drainage (CTD) of pancreatic pseudocysts by endoscopy in many centers, its superiority with ­respect to technical success and clinical outcome has not yet been demonstrated in a prospective randomized trial. We conducted this prospective randomized trial to compare the technical success and clinical outcomes of EUD and CTD in treating pancreatic pseudocysts. Patients and methods: A total of 60 consecutive patients with pancreatic pseudocysts were randomly divided into two groups to undergo either EUD (n = 31) or CTD (n = 29) of pancreatic pseudocysts. The technical success rate, complications, and short-term and long-term results were prospectively evaluated. Results: The rate of technical success of the ­drain­age was higher for EUD (94 %, 29 / 31) than for CTD (72 %, 21 / 29; P = 0.039) in intention-to-treat analy­sis. In cases where CTD failed (n = 8), because the pseudocysts were non-bulging, a crossover was made to EUD, which was successfully performed in all these patients. Complica­tions occurred in 7 % of the EUD and 10 % of the CTD group (P = 0.67). During short-term follow-up, pseudocyst resolution was achieved in 97 % (28 / 29) in the EUD group and in 91 % (19 / 21) in the CTD group (P = 0.565). Long-term results analyzed on a per-protocol basis showed no significant difference in clinical outcomes be­tween EUD (89 %, 33 / 37) and CTD (86 %, 18 / 21, P = 0.696). Conclusions: We found that EUD and CTD can both be considered first-line methods of endo­scop­ic transmural drainage of bulging pseudocysts, whereas EUD should be preferred for non-bulging pseudocysts.

Schlüsselwörter

Pankreaspseudozysten - endoskopische transmurale Dränage - EUS-gesteuerte Dränage - ERCP-gesteuerte Dränage

Key words

pancreatic pseudoycsts - endoscopic transmural drainage - EUS-guided drainage - ERCP-guided drainage

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