Endoscopic ultrasound- guided drainage of post-operative peripancreatic fluid collections utilising lumen apposing metal stents with or without coaxial double pigtail plastic stent

Aims Endoscopic ultrasound (EUS)- guided drainage is a safe and effective method of treating walled-off necroses and pseudocysts which can occur after a case of acute pancreatitis. A substantial number of patient who have undergone surgery of the pancreas can also develop peripancreatic fluid collections (PFC) such as abscesses and heamatomas. Our aim is to prove that EUS-guided drainage of such fluid colections is a safe and efficient method of managing these surgical complications.

Methods In this summary we included 15 patient who have undergone EUS-guided drainage of post- operative PFC. 2 of them had 2 drainages- one had three abscesses, two of them resolved after initial drainage but the third one had to be drained separately, the other one had a complex abscess and a section was separated from the main part before being completely drained and it required placing a second stent. We included patient after distal pancreatectomy (12), pancreatoduodenectomy (2) and tumorectomy (1). The indications for surgery were: pancreatic cancer, walled-off necrosis, neuroendocrine tumor, serous cystadenoma, renal cancer metastases, solid psueduopapillary neoplasm, and cholangiocarcinoma. We used primarily lumen apposing metal stents (LAMS), in some cases we added a coaxial 7F double pigtail stent to stabilise LAMS, facilitate better drainage and to prevent stent closure and bleeding from opposing wall [1] [2] [3].

Results Technical success was defined as creating a fistula between upper digestive tract and lumen of the PFC and placing a patent LAMS. Clical success was defined as complete or almost complete resolution of the cyst, symptomatic relief and discharge from the hospital. Technical success was achieved in 16 procedures. In the case of afformentioned patient who required a second drainage for another abscess a stent migration occured and patient was submitted to surgery. One patient was submitted to surgery one day after stent placement due to symptoms of peritonitis- the implanted stent has perforated the abscess wall. Median days to discharge was 6 (mean: 9,6). Median days since initial surgery to drainage procedure was 25 (mean: 77,2).

Conclusions The EUS guided drainage of post-operative PFCs with LAMS is a minimally invasive procedure. It is safe and efficient. Given that more than 20% patients submitted to distal pancreatectomy develop abscesses it seems relevant to expand available methods of managing those complications in centers that perform pancreatic surgery. The method has proven itself useful in post-inflammatory PFCs and with more data it might become method of choice in treatment of post-operative PFC.

Publication History

Article published online:
27 March 2025

• References

• 1 Nakano Y, Endo Y, Kitago M. et al. Clinical characteristics and predictive factors of postoperative intra-abdominal abscess after distal pancreatectomy. Langenbecks Arch Surg 2023; 408 (1): 170 Published 2023 May 2
• 2 Zhu H, Du Y, Wang K, Li Z, Jin Z.. Consensus guidelines on the diagnosis and treatment of pancreatic pseudocyst and walled-off necrosis from a Chinese multiple disciplinary team expert panel. Endosc Ultrasound 2024; 13 (4): 205-217
• 3 Capurso G, Rizzo GEM, Coluccio C. et al. The i-EUS consensus on the management of pancreatic fluid collections – Part 1. Dig Liver Dis 2024; 56 (10): 1663-1674