Acute and early EUS-guided transmural drainage of symptomatic postoperative fluid collections

The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery

“…Two more recent studies comparing early drainage and delayed drainage then showed comparable clinical success and adverse events between the two groups [16,17]. Subgroup analysis in one of these studies even demonstrated no significant difference in terms of clinical outcomes or complications for patients undergoing acute drainage within 14 days of surgery [17]. These results were then replicated in dedicated studies comparing acute EUSguided drainage within two weeks of surgery to those performed after two weeks [18,19].…”

“…Tilara et al first demonstrated that early drainage within 30 days after surgery had similar technical success rates, as well as adverse events, compared to delayed drainage [7]. Two more recent studies comparing early drainage and delayed drainage then showed comparable clinical success and adverse events between the two groups [16,17]. Subgroup analysis in one of these studies even demonstrated no significant difference in terms of clinical outcomes or complications for patients undergoing acute drainage within 14 days of surgery [17].…”

Multidisciplinary Management of Postoperative Pancreatic Fistula

“…110 However, there is mounting evidence to suggest that EUS-guided drainage of symptomatic postoperative fluid collections can be safely performed earlier than 4 weeks, even in the absence of a thick wall. 111 A recent retrospective analysis of consecutive patients undergoing EUS-guided transmural drainage as early as 6 to 14 days postoperatively achieved a high rate of clinical success (95%) that did not significantly differ from those who were drained more than 30 days postoperatively, with a similar rate of adverse events. 111 In addition, necrosectomy was required less often in patients who underwent EUS-guided drainage earlier as compared with later than 30 days postoperatively.…”

“…111 A recent retrospective analysis of consecutive patients undergoing EUS-guided transmural drainage as early as 6 to 14 days postoperatively achieved a high rate of clinical success (95%) that did not significantly differ from those who were drained more than 30 days postoperatively, with a similar rate of adverse events. 111 In addition, necrosectomy was required less often in patients who underwent EUS-guided drainage earlier as compared with later than 30 days postoperatively. 111 Complications of EUS-guided drainage of fluid collections include secondary infection, bleeding (immediate or delayed), perforation, and stent maldeployment and/or delayed migration.…”

“…111 In addition, necrosectomy was required less often in patients who underwent EUS-guided drainage earlier as compared with later than 30 days postoperatively. 111 Complications of EUS-guided drainage of fluid collections include secondary infection, bleeding (immediate or delayed), perforation, and stent maldeployment and/or delayed migration. 110 The majority of these complications can be treated by repeat endoscopic therapy.…”