Differentiated approach to transmural endoscopic drainage in patients with pancreatic fluid formations

Introduction. Currently, indications for the choice of the type of transmural drainage (TMD) for pancreatic fluid collection, drainage timing and a dynamic monitoring program for the prevention of relapses and complications have not been formed.

The purpose of the study. To improve the result of treatment in patients with fluid formations of the pancreas.

Materials and methods. The results of using TMD in 54 patients with fluid formations of the pancreas in the period from 2012 to 2022 were analyzed. Active transmural drainage (ATMD) was performed in 38 cases, passive transmural drainage (PTMD) was performed in 16 cases. Long-term results of transmural drainage were evaluated in 29 patients. In 10 observations, the functioning of the internal postoperative pancreatic fistula in the long-term period was studied.

Treatment results. A statistically significant difference was revealed in the clinical success, the frequency of complications when performing active and passive TMD of liquid formations with a density of 15HU. Statistically significant associations were revealed between the TMD method, the density of liquid formations, clinical efficacy and the frequency of stent obturation. When assessing long-term results, relapses are observed during migration and removal of the stent earlier than 24 months in the presence of a damaged main pancreatic duct.

Conclusion. The data obtained as a result of the study indicate that the choice of the method of endoscopic drainage of the LV should be carried out based on the results of studying the density of the contents of the liquid formation measured by computed tomography. Thus, with a density of liquid formations ≥ 15HU, it is advisable to perform active drainage using cystonasal drainage. The decision to remove the stent in the absence of liquid formations according to ultrasound and CT is advisable to take after assessing the level of amylase in the cystogastric anastomosis.

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