Serious complications have been reported in all endoscopic PP drainage series. Many can be avoided and others can be non-surgically managed. PATIENTS: At 3 referral medical centers. 108 consecutive patients underwent attempted endoscopic PP drainage from 3/89 to 8/95. and all complications were recorded and followed for a minimum of 4 months (mean=11 mon.). Criteria for intervention, and clinical features of this expanding mixed group were reported previously (Gastroint Endosc 1995;41:424A). Management, outcome, and changes in technique were noted. RESULTS: 25 (2390 complications were observed. Bleeding was noted in 3, due to incisional drainage in I, and unrecognised pseudoaneursym in 2. Surgery was needed in 2. and 1 was embolized by radiology. After adopting balloon tract dilatation, no further gastric wall bleeding occurred. Perforation into the retroperitoneum was noted in 4 and required surgery in 2. The technique of endoscopic needle localization prior to puncture avoided perforation after its adoption. Infection of the residual pseudocyst cavity occurred in 13 and was managed with additional endoscopic drainage in 10, radiologic drainage in 1 and surgery in 2. After the recognition of the importance of the presence of necrosis, the creation of a larger tract by repeated 8mm balloon dilatations, placement of multiple 10 Fr stems, and prolonged nasocystic catheter lavage has reduced the need for surgery and rehospitalization. Of the 7 patients requiring surgery for management of complications, only 1 has been required in the last 25 patients. CONCLUSION: Complications occur frequently in patients undergoing endoscopic pseudocyst drainage, especially in the setting of complex pseudoeysts and necrosis. Complications can often be managed endoscopically or hopefully avoided with modification of technique and experience.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging