Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: role of cause and severity of pancreatitis.

PURPOSE: To assess the relationship between the cause and severity of pancreatitis and the development of persistent pancreatocutaneous fistula (PPCF) after percutaneous drainage of pancreatic fluid collections. MATERIALS AND METHODS: Sixty patients (44 male, 16 female; age range, 10-74 years) were included in the study. The cause of pancreatitis was postoperative in 29 patients, alcoholism in 20 patients, biliary in six patients, hyperlipidemia in two patients, unknown in two patients, and trauma in one patient. Patients requiring intensive care unit treatment for their condition at the time of drainage were considered to have severe pancreatitis. Thirty-seven patients had mild pancreatitis, and 23 had severe pancreatitis. PPCF was defined as catheter drainage of pancreatic fluid of more than 10 mL/d for more than 4 weeks after catheter placement. RESULTS: PPCF developed in 27 of the 60 patients. It occurred in five of the six patients with biliary pancreatitis, 10 of the 20 with alcohol-related pancreatitis, and 10 of the 29 with postoperative pancreatitis (P > .2). The prevalence of PPCF was higher in patients with severe pancreatitis (n = 16 [70%]) than in those with mild pancreatitis (n = 11 [30%]). This difference was statistically significant (P < .002). CONCLUSION: Development of PPCF correlated with severity of pancreatitis, regardless of the cause of pancreatitis.

Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance.

OBJECTIVE: The study was designed to evaluate the safety, efficacy, and usefulness of the performance of percutaneous radiologic (PRG) and endoscopic (PEG) gastrostomy. MATERIALS AND METHODS: This study involved a retrospective review of 182 percutaneous gastrostomy procedures (68 PRG, 114 PEG) performed over a 3-year period. Parameters analyzed included technical success, procedure duration, anesthetic requirements, incidental findings on endoscopy, and complications. RESULTS: The success rate for tube placement was higher for PRG than for PEG (100% versus 95%). PRG was subsequently performed in four of six patients in whom PEG procedures failed. Mean procedure duration was shorter for PRG than for PEG (32.9 min versus 39.1 min, p < .05). PRG was performed without conscious sedation (i.e., local anesthesia only) more frequently than was PEG (25% versus 0%, p < .001). The mean volume of doses of midazolam hydrochloride administered during PRG was two thirds of the volume of doses used during PEG. Incidental abnormalities were detected in 32 (30%) of the successful PEG procedures, 11 (10%) of which resulted in biopsy or medical therapy. No biopsy specimen showed evidence of malignancy. One (0.9%) patient received treatment other than gastric acid medication. Three (3%) major postprocedural complications occurred immediately after PEG and none (0%) occurred after PRG. CONCLUSION: The significant advantages of PRG over PEG included higher success rates, shorter procedure duration, and less conscious sedation required. PRG was also successful with patients for whom PEG failed.

Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature.

PURPOSE: To evaluate the effectiveness and safety of radiologic, percutaneous endoscopic (PEG), and surgical gastrostomy. MATERIALS AND METHODS: This project involved 5,752 patients (837 patients underwent radiologic gastrotomy; 4,194, PEG; and 721, surgical gastrostomy). Seventy-two (47 male, 25 female; age range, 12-94 years) underwent gastrostomy within 1 year in this series (radiologic gastrostomy, n = 33; PEG, n = 35; surgical gastrostomy, n = 4). A meta-analysis of 5,680 additional cases from literature published from 1980 to the present was also performed. RESULTS: Rates of successful tube placement were higher for radiologic gastrostomy than for PEG in our series and in the meta-analysis (99.2% vs 95.7%, P < .001). Major complications occurred less frequently after radiologic gastrostomy in our series and in the meta-analysis (5.9% vs 9.4% for PEG and 19.9% for surgery, P < .001). Thirty-day procedure-related mortality rates were highest for surgery (2.5% vs 0.3% for radiologic gastrostomy and 0.53% for PEG, P < .001). CONCLUSION: Radiologic gastrostomy is associated with a higher success rate than is PEG and less morbidity than either PEG or surgery.