Timing of Endoscopic Drainage of Pancreatic Collections: A Multicenter Retrospective Study

Aims Pancreatic collections (PC) are a common complication of acute pancreatitis (AP), requiring drainage when symptomatic or infected. Endoscopic ultrasound (EUS)-guided drainage is the preferred approach, yet the optimal timing remains debated. While some studies support a step-up approach with delayed intervention, evidence on EUS-guided drainage timing is limited.

Methods This retrospective multicenter study analyzed 45 patients who underwent EUS-guided drainage of symptomatic PC in three Portuguese hospitals between 2018 and 2024. Patients were divided into immediate (< 4 weeks, n=20) and postponed (> 4 weeks, n=25) groups. Metal stents were used in all cases. Primary outcomes included technical and clinical success rates. Secondary outcomes evaluated stent removal timing, additional procedures, complications, and mortality.

Results Technical success was achieved in 100% of cases in both groups. Clinical success rates were high, with earlier drainage showing no evidence of inferiority compared to postponed drainage (95.0% vs. 76.0%, p=0.081, Fisher’s one-sided p=0.089). Although not statistically significant, this trend suggests comparable outcomes for earlier intervention when clinically indicated. Pancreatic collections were smaller in the immediate group (11.6 cm vs. 13.9 cm). Necrosis>30% (52% vs. 40%) and paracolic gutter extension (56% vs. 30%) were more frequent in the postponed group. Fewer patients in the immediate group required additional interventions, though the mean number of necrosectomies was slightly higher (2.28 vs. 1.91). Stents were removed sooner in the immediate group (25.2 vs. 31.3 days), while hospitalization was longer in the postponed group (61 vs. 48.5 days). Adverse events were less frequent in the immediate group (10.0% vs. 16.0%), with no procedure-related mortality. Subgroup analysis revealed that patients with extensive necrosis or paracolic gutter extension had lower clinical success rates and required more procedures, irrespective of timing [1] [2] [3] [4] [5].

Conclusions These findings demonstrate that EUS-guided drainage of symptomatic PC is both effective and safe, regardless of timing, provided it is clinically indicated. Earlier drainage was associated with shorter hospitalization and showed no inferiority in clinical success compared to postponed drainage. The higher prevalence of necrosis and paracolic gutter extension in the postponed group likely influenced outcomes, reinforcing the need for individualized decision-making. These results challenge the conventional guideline preference for delayed drainage and support the use of earlier intervention as a viable and effective option when indicated.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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