Predictors of clinical success in EUS-guided drainage of postoperative pancreatic fluid collections

Aims There has been a shift from percutaneous drainage towards endoscopic ultrasound (EUS)-guided drainage for management of post-operative pancreatic fluid collections (POPFC). However, available series have been limited by sample size and little is known about the factors that may influence clinical success. Our aim was to evaluate the outcomes of EUS-guided drainage of postoperative collections following pancreatic surgery and identify predictors of clinical success.

Methods We performed a retrospective review of patients who underwent EUS-guided drainage of POPFC at three academic centers between 2014 and August 2024. Patients with a history of non-pancreatic surgery were excluded. LAMS or double pigtail plastic stents (DPPS) were used at the discretion of the endoscopist. Primary outcome was clinical success, defined as the complete radiological regression of the collection and resolution of symptoms without the need for additional drainage procedures. Secondary outcomes were technical success, defined as successful stent placement, and adverse events (based on the AGREE classification).

Results In total, 270 cases were included (mean age 63 [SD±13.9] years, male 58%). Early drainage (≤ 14 days) was performed in 51% of cases (n=138). The most common reasons for surgery were pancreatic ductal adenocarcinoma (34.7%), NET (20.7%) and cholangiocarcinoma (6.3%). Majority of patients had a recent history of either pylorus-resecting pancreatoduodenectomy or distal pancreatectomy with splenectomy (35.9% and 33.7% respectively). DPPS were used in 213 cases (78.9%), whereas LAMS were used in 42 cases (15.6%). Clinical success with a single EUS drainage procedure was achieved in 163 cases (60%). Step-up interventions were required in 25.6% of patients (n=69). Of these, 41 cases required endoscopic revision only, with an overall median number of reinterventions of 0 (IQR 0-1, mean 0.42 [SD±0.95]). Technical success was achieved in 90% (n=243). Adverse events occurred in 46 cases (17%), with 3 cases requiring surgery (grade IIIB, 1%). Univariate analysis did not reveal any major predictors of clinical success, including LAMS vs. DPPS (OR 0.61 [95% CI: 0.29-1.29], p=0.193), early vs. late drainage (OR 0.87 [95% CI: 0.53-1.41], p=0.565), splenectomy vs. no splenectomy (OR 0.92 [95% CI 0.55-1.53), p=0.752) or duodenal vs. transgastric route (OR 1.05 [95% CI: 0.25-4.50], p=0.947).

Conclusions EUS-guided drainage of POPFC was effective in the majority of cases with a single procedure. No major predictors of clinical success were identified. When reintervention was required, a single endoscopic reintervention was sufficient in 54% of cases. These results further support the use of EUS-guided drainage for the management of postoperative collections.

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Artikel online veröffentlicht:
27. März 2025