Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study / Fluoroscopia vs no fluoroscopia en el drenaje transmural de colecciones pancreáticas guiado por ecoendoscopia: estudio comparativo

Introduction: The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. Aims: The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). Methods: This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. Results: Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). Conclusions: Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups (AU)

Introducción: La necesidad de la ayuda de fluoroscopia en pacientes que se les realiza un drenaje transmural guiada por ecoendoscopia (USE) de colecciones pancreáticas (CP) no está claro. Objetivo: El objetivo de este estudio fue comparar los resultados generales del drenaje transmural de CP con ayuda de fluoroscopia (F) versus sin fluoroscopia (SF). Métodos: Estudio comparativo, análisis retrospectivo, con inclusión prospectiva y consecutiva en una base de datos específica. Estudio realizado en un centro universitario terciario, en el periodo entre 2009 y 2015. Todos los pacientes fueron seudoquistes (PSQ) o colecciones pancreáticas necróticas encapsuladas (CPN) con clínica asociada. Se asignaron 2 grupos dependiendo de la disponibilidad de la fluoroscopia. Grupos heterogéneos respecto a sus características demográficas, CP y procedimientos. El estudio analizó el éxito técnico, el éxito clínico, las incidencias, los eventos adversos y el seguimiento. Resultados: Cincuenta drenajes transmurales guiados por USE de CP, de un total de 86 drenajes por USE, fueron incluidos durante el periodo del estudio. El grupo F incluyó 26 procedimientos, PSC 69,2%, CPN 30,8%, prótesis metálicas 61,5% (46,1% prótesis de aposición luminal) y plásticas 38,5%. El grupo SF incluyó 24 procedimientos, PSQ 37,5%, CPN 62,5% y prótesis metálicas 95,8% (prótesis de aposición luminal). Éxito técnico del 100% en ambos grupos, éxito clínico clínico similar (F 88,5%, FL 87,5%). Incidencias técnicas y eventos adversos intraprocedimiento: solo descritos en grupo F (7,6% y 11.5%, respectivamente) y ninguna en el grupo SF. Tiempo del procedimiento menor en grupo SF (8min, p=0.0341). Conclusiones: El drenaje transmural de CP sin ayuda de fluoroscopia no comportó mayor número de incidencias técnicas o eventos adversos intraprocedimiento. Los éxitos técnico y clínico fueron similares en ambos grupos (AU)

Analgesia with continuous wound infusion of local anesthetic versus saline: Double-blind randomized, controlled trial in hepatectomy.

BACKGROUND: Surgical wound is source of pain in hepatectomy with laparotomy. Continuous wound infusion of ropivacaine may provide effective analgesia. METHODS: This prospective, randomized trial, patients scheduled for hepatectomy received a 48-h preperitoneal continuous wound infusion of either 0.23% ropivacaine or 0.9% saline at 5 ml/h. Primary endpoint was 48 h morphine consumption. RESULTS: 53 patients included in the ropivacaine group and 46 in the saline group. Morphine consumption was 24.63 mg in the ropivacaine group, and 26.78 mg (p = 0.669) in the saline group. Pain was comparable between groups and there were no differences in solid food intake, ambulation, or length of hospital stay. No local or systemic complications were recorded. CONCLUSIONS: Continuous wound infusion with ropivacaine is safe, but it neither reduced morphine consumption nor enhanced recovery in patients undergoing hepatectomy. Success of enhanced recovery in hepatectomy is not influenced by the analgesic regimen if pain is well controlled.

Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study.

INTRODUCTION: The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. AIMS: The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). METHODS: This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. RESULTS: Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). CONCLUSIONS: Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups.