EUS versus percutaneous management of postoperative pancreatic fluid collection: A systematic review and meta-analysis

Mohan, Babu P.; Shakhatreh, Mohammed; Dugyala, Sushma; Geedigunta, Vaishali; Gadalay, Ashwini; Pahal, Parul; Ponnada, Suresh; Nagaraj, Kapil; Asokkumar, Ravishankar; Adler, Douglas G.

doi:10.4103/eus.eus_18_19

Cited by 18 publications

(9 citation statements)

References 33 publications

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“…There were no statistically significant differences in outcome measures between the two groups. A recent systematic review and meta-analyses by Mohan et al [ 32 ] has confirmed findings of these isolated studies and inferred that in terms of clinical outcome, EUS guided drainage is a safe, effective, and preferable modality for the management of POPFC. However, regarding adverse events and technical success rate, EUS guided drainage is similar to PCD.…”

Section: Discussionmentioning

confidence: 87%

Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature

Chhabra

Maher

Trivedi

et al. 2021

Ann Hepatobiliary Pancreat Surg

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Post-operative pancreatic fistulas (POPF) and fluid collections (POPFC) remain significant sources of morbidity and mortality after pancreatic resections. There remains a paucity of literature describing endoscopic ultrasound (EUS) guided drainage of POPFC using a Hot AXIOS TM lumen apposing metal stent (LAMS). Methods: We conducted a retrospective study, encompassing all consecutive patients with POPFC managed using Hot AXIOS TM LAMS at our institution between January 2017 and December 2019. Primary outcome measures were technical and clinical success. Secondary outcome measures were adverse events and recurrence rates. Results: Five patients underwent EUS guided drainage using Hot AXIOS TM LAMS during the study period. Mean age of patients was 67.8 ± 2.16 years. The majority (60.0%) of patients were males. Median duration of symptom onset after surgery was 9 days. All patients presented with abdominal pain. Median size of the collection measured on computed tomography was 91 mm. Median interval time between symptom onset and EUS drainage was 30 days. Two patients required percutaneous drainage prior to EUS guided drainage. Technical and clinical success were achieved for all patients. No adverse events were observed. Median duration of follow-up was 90 days. No recurrence of collection occurred during the follow-up period. Conclusions: EUS guided drainage of POPFC using Hot AXIOS TM LAMS is a safe and effective treatment modality with technical and clinical success rates of 100% in our experience.

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Section: Discussionmentioning

confidence: 87%

Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature

Chhabra

Maher

Trivedi

et al. 2021

Ann Hepatobiliary Pancreat Surg

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“…A meta-analysis of 13 studies by Mohan et al. [ 33 ] reported that ED and PD had similar adverse events and technical success. ED outperformed PD in clinical success (93.2% vs. 79.8%, p = 0.002), disease recurrence, and PF management.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis

et al. 2023

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Background/Aims Pancreatic fluid collections (PFC) are debris or fluid of the pancreas that needs to be drained out. This may result from surgery or necrotizing pancreatitis. This meta-analysis compared the outcomes of PFC through endoscopic and percutaneous interventions. Methods A medical database was searched up to June 2022, comparing the outcomes of endoscopic drainage (ED) and percutaneous drainage (PD) for the PFC. Eligible studies reporting clinical and technical success and adverse events were selected. Results Seventeen studies with 1170 patients were included for meta-analysis, of which 543 patients underwent ED and 627 underwent PD. The odd ratio (OR) of technical success was 0.81 (95% confidence interval (CI) 0.31, 2.1) and clinical success was in the favor of the ED group at OR 2.23 (95% CI 1.45, 3.41). Adverse events OR 0.62 (95% CI 0.27, 1.39) and stent migration OR 0.61 (95% CI 0.10, 3.88) were the same in both groups, but hospital stay pooled mean difference of 15.02 days (95% CI 9.86, 20.18), mortality OR 0.24 (95% CI 0.09, 0.67), and re-interventions OR 0.25 (95% CI 0.16, 0.40) favored ED. Conclusions ED is safe and efficient for PFC with higher clinical success, lower mortality rate, hospital stay, and re-interventions compared with PD.

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“…POFCs are well-recognised adverse events after pancreatobiliary surgery and can occur despite the best efforts to prevent them. Traditional treatments of surgical drainage and PD are associated with increased morbidity and reduced quality of life, respectively [20]. EUS-guided internal drainage avoids these problems and results in less fluid and/or electrolyte loss and fewer infective complications [3].…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

“…While there are no randomised trials on this subject, a recent meta-analysis has shown that EUS-guided drainage is superior to PD in terms of clinical success and recurrence of POFC [20]. This result and recommendation must be interpreted with care as these studies were mostly performed in tertiary centres by experienced and expert proceduralists.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

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

Ong

Chong

2021

Gastroenterology Insights

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Postoperative fluid collection (POFC) is a challenging complication following pancreatobiliary surgery. Traditional treatment with surgical drainage is associated with significant morbidity, while percutaneous drainage is associated with a higher rate of recurrence and the need for repeated interventions. Studies have shown that endoscopic ultrasound (EUS)-guided drainage may offer a promising solution to this problem. There are limited data on the ideal therapeutic protocol for EUS-guided drainage of POFC including the timing for drainage; type, size, and number of stents to use; and the need for endoscopic debridement and irrigation. Current practices extrapolated from the treatment of pancreatic pseudocysts and walled-off necrosis may not be applicable to POFC. There are increasing data to suggest that drainage procedures may be performed within two weeks after surgery. While most authors advocate the use of double pigtail plastic stents (DPPSs), there have been a number of reports on the use of novel lumen-apposing metal stents (LAMSs), although no direct comparisons have been made between the two.

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EUS versus percutaneous management of postoperative pancreatic fluid collection: A systematic review and meta-analysis

Cited by 18 publications

References 33 publications

Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature

Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature

Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis

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

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