Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: success and complication rates P. Chahal, G. I. Papachristou, T. H. Baron Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA Received: 3 October 2006/Accepted: 18 January 2007/Online publication: 1 March 2007 Abstract Background: Endoscopic drainage of pancreatic fluid collections (PFC) is performed with increasing fre- quency. A variety of techniques for performing trans- mural entry have been described. However, data are lacking on the technical success and safety of transmural entry using a single technique. The authors describe the largest experience in transmural entry of PFCs without endoscopic ultrasound (EUS) guidance using a dedi- cated aspiration needle. Methods: All patients who underwent endoscopic trans- mural drainage of PFC from October 1998 to May 2006 were identified from the endoscopy database. Data were abstracted from the endoscopic procedure report and the patient records then placed in a JMP drive. All drainages were performed without EUS guidance after visualiza- tion of an obvious intraluminal bulge using a dedicated large-bore aspiration needle. The transmural tract into the PFC was dilated using a balloon with a diameter of 6 to 20 mm followed by subsequent placement of one or two 10-Fr double pigtail stents with or without nasocystic irrigation tubes. Successful entry was defined as entry allowing for the placement of stents. Results: No significant difference in the complication rates was observed when they were analyzed for the fol- lowing variables: age, gender, balloon diameter, presence of endoscopic impression, drainage approach, and size and type of fluid collection. Conclusion: Endoscopic transmural drainage of pancre- atic fluid collections can be performed safely and effec- tively via the Seldinger technique without endoscopic ultrasound guidance. The study data will allow sample size calculations to be made if direct comparisons with this technique and others are undertaken. Key words: Dedicated aspiration needle — Endoscopic drainage — Endoscopic transmural entry — Pancreatic fluid collections — Seldinger technique Endoscopic therapy of pancreatic fluid collections (PFCs) is increasingly being performed. The nomenclature for classifying PFCs arising as a consequence of acute pan- creatitis was defined at the Atlanta symposium in 1992 [1]. Acute pancreatitis may result in the formation of pan- creatic necrosis, pancreatic pseudocyst, pancreatic ab- scess, or acute fluid collections. Chronic pancreatitis may result in chronic pancreatic pseudocysts [2]. Intervention is indicated for symptomatic or infected PFCs. The different therapeutic methods for managing PFCs are surgical, percutaneous, and endoscopic pro- cedures. Although surgical drainage has been considered the gold standard, it is accompanied by significant morbidity and mortality [3–6]. Similarly, imaging-gui- ded percutaneous drainage has the disadvantage of causing pancreaticocutaneous fistulae and the discom- fort of an external catheter. Since the original description of endoscopic PFC drainage more than two decades ago [7–9], endoscopic management has evolved and currently is considered an acceptable alternative to surgical therapy. Numerous series have reported the safety and effectiveness of endoscopic PFC drainage when performed by experi- enced endoscopists [15–37]. Endoscopic drainage of PFCs can be performed by transmural or transpapillary placement of endopros- thesis. Transmural drainage can be performed with or without endoscopic ultrasound (EUS) guidance [29–38]. The options for transmural entry into a collection in- clude electrocautery with a variety of endoscopic instruments such as the needle-knife, fistulotome, or large-bore surgical needle using the Seldinger technique without the aid of electorcautery [23]. Correspondence to: T. H. Baron Surg Endosc (2007) 21: 1726–1732 DOI: 10.1007/s00464-007-9236-6 Ó Springer Science+Business Media, LLC 2007