ORIGINAL ARTICLE Endoscopic Transmural Drainage of Peripancreatic Fluid Collections: Outcomes and Predictors of Treatment Success in 211 Consecutive Patients Shyam Varadarajulu & Ji Young Bang & Milind A. Phadnis & John D. Christein & C. Mel Wilcox Received: 13 April 2011 /Accepted: 12 July 2011 /Published online: 23 July 2011 # 2011 The Society for Surgery of the Alimentary Tract Abstract Objectives Endoscopy is a minimally invasive technique for the drainage of peripancreatic fluid collections. This study evaluated the clinical outcomes and predictors of treatment success in consecutive patients undergoing endoscopic transmural drainage of peripancreatic fluid collections. Methods This is a retrospective study of patients who underwent endoscopic drainage of peripancreatic fluid collections over 7 years. Prior to drainage, an ERCP was attempted for stent placement in all patients with a pancreatic duct leak. Drainages were performed using conventional endoscopy or endoscopic ultrasound. Transmural stents and/or drainage catheters were deployed and endoscopic necrosectomy was undertaken when required. Data on clinical outcomes and complications were collected prospectively. Results A total of 211 patients underwent drainage of peripancreatic fluid collections that was classified as pseudocyst in 45%, abscess in 28%, and necrosis in 27%. Mean diameter of the fluid collection was 100.6 mm, and 34.5% of patients had pancreatic duct stent placement. Median duration of follow-up was 356 days. Treatment success was 85.3% and was higher for pseudocyst and abscess compared to necrosis (93.5% vs. 63.2%, p <0.0001). Complications were encountered in 17 patients (8.5%) and was higher for drainage of necrosis than pseudocyst or abscess (15.8% vs. 5.2%, p =0.02). Treatment success was more likely for patients with pseudocyst or abscess than necrosis (adjusted OR=7.6, 95% CI [2.9, 20.1], p <0.0001) when adjusted for serum albumin and white cell count, type of endoscopic modality or accessory used, pancreatic duct stenting, luminal compression, size and location of fluid collection. Conclusions Endoscopic therapy is a highly effective technique for the management of patients with non-necrotic peripancreatic fluid collections. Keywords Endoscopic drainage . Endoscopic ultrasound- guided drainage . EUS . Pancreatic fluid collections . Pancreatic pseudocysts . Pancreatic necrosis . Pancreatic abscess Introduction Peripancreatic fluid collections (PFCs) can arise as a result of acute or chronic pancreatitis, trauma, malignancy, or surgery. 1,2 Drainage of these PFCs may be necessary as they can result in abdominal pain, gastric outlet or biliary obstruction, infection, and rarely rupture. 3,4 S. Varadarajulu : J. Y. Bang : M. A. Phadnis : C. M. Wilcox Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA J. D. Christein Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA S. Varadarajulu (*) Basil I. Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, JT 664, 1530-3rd Ave. S, Birmingham, AL 35294-0012, USA e-mail: svaradarajulu@uab.edu J Gastrointest Surg (2011) 15:2080–2088 DOI 10.1007/s11605-011-1621-8