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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic transgastric fenestration versus percutaneous drainage for management of (peri)pancreatic fluid collections adjacent to gastric wall (with video)
Hong-Mei Zhang, Hui-Ting Ke, Md Robin Ahmed, Ya-Juan Li, Ghulam Nabi, Mu-Han Li, Ji-Yu Zhang, Dan Liu, Li-Xia Zhao, Bing-Rong Liu
Hong-Mei Zhang, Md Robin Ahmed, Ya-Juan Li, Mu-Han Li, Ji-Yu Zhang, Dan Liu, Li-Xia Zhao, Bing-Rong Liu, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Hui-Ting Ke, Department of Ultrasound, Ezhou Central Hospital, Ezhou 436099, Hubei Province, China
Ghulam Nabi, Institute of Nature Conservation, Polish Academy of Sciences, Krakow 31120, Poland
Bing-Rong Liu, State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Co-first authors: Hong-Mei Zhang and Hui-Ting Ke.
Author contributions: Zhang HM, Ke HT and Li YJ contributed to the design of the study, collected data and drafted the manuscript; Ke HT and Nabi G performed the data analysis; Ahmed MR, Liu D and Zhao LX conceived the work; Zhang JY and Li MH contributed to video clip of endoscopic transgastric fenestration; Liu BR revised the manuscript; All authors issued final approval for the version to be submitted. Here are the reasons for designating Zhang HM and Ke HT as co-first authors: During the period of the study, Ke HT was a postgraduate student of the First Affiliated Hospital of Zhengzhou University and fully participated in the study. Ke HT graduated one year ago and worded in Ezhou Central Hospital. Zhang HM and Ke HT proposed the concept of this study, searched relevant literature and then discussed the research design together, and finally determined the research idea. Before the paper was drafted, they collected the research data together, and carried out the collation, statistical analysis and later verification work. They worked together on the first draft. Zhang HM explained the data charts and graphs and Ke HT selected typical case pictures and illustrated them.
Supported by Zhongyuan Talent Program, No. ZYYCYU202012113; The Key R and D Program of Henan Province, No. 222102310038.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University.
Informed consent statement: All study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bing-Rong Liu, PhD, Chief Physician, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450000, Henan Province, China. fccliubr@zzu.edu.cn
Received: July 24, 2023
Peer-review started: July 24, 2023
First decision: September 18, 2023
Revised: October 1, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: October 28, 2023
ARTICLE HIGHLIGHTS
Research background
Percutaneous drainage (PCD) and endoscopic approaches with stent implantation have largely replaced surgical drainage as the initial approach for (peri) pancreatic fluid collections (PFCs). While stent implantation guided by endoscopic ultrasound has been mature and preferred treatment, but stent displacement, bleeding and embedding should not be neglected.
Research motivation
Inspired by endoscopic full-thickness resection, we conducted endoscopic transgastric fenestration (ETGF), which involves resection of connected tissues between gastric wall and PFCs, so as to drain the collection of fluid in the cavity and debride the necrosis inside.
Research objectives
The study aimed to evaluate the efficacy and safety of ETGF by accessing its success and complication rate compared with PCD.
Research methods
This retrospective analysis enrolled patients diagnosed with PFCs adjacent to the gastric wall and subsequently received ETGF or PCD during 4 years, analyzed patients baseline characteristics, technical and clinical success rate, recurrence and reintervention rate, procedure related complication and adverse events.
Research results
Seventy-two eligible patients were retrospectively identified (ETGF = 34, PCD = 38). Patients in the ETGF group acquired significantly higher clinical success rate than that in PCD (97.1 vs 76.3%, P = 0.01). There was no statistical difference about recurrence, reintervention and incidence of complication between the two groups.
Research conclusions
ETGF would be an alternative effective and safe strategy for the treatment of PFCs adjacent to the gastric wall.
Research perspectives
ETGF can drainage fluid inside and debride necrosis, which improves its clinical success. Therefore, in our opinion ETGF may be an alternative treatment for PFCs adjacent to gastric, especially for large lesions or leions that associated with infection or necrosis.
