Management of peripancreatic fluid collections following partial pancreatectomy: a comparison of percutaneous versus EUS-guided drainage

Abstract

EUSD of postoperative PFCs appears to be safe and technically feasible. This technique appears to be as successful as PD for the management of PFCs with the advantage of not requiring an external drainage apparatus and should be considered as a therapeutic option in this group of patients. Further evaluation, with analysis of cost and quality of life, should be considered in a prospective, randomized trial.

Postoperative abdominal collections drainage: Percutaneous versus guided by endoscopic ultrasound

“…Of the patients with recurrence, two underwent surgery without a new EUS‐GD or PD, one patient had one more EUS‐GD, and one patient had two more EUS‐GD before surgery; none had PD. Median number of procedures in the EUS‐GD group was one …”

“…Postoperative fluid collections (POFC) are a significant cause of morbidity following intra‐abdominal surgical procedures . POFC may be asymptomatic, but some can lead to severe pain, gastric outlet obstruction, intra‐abdominal infection and sepsis.…”

Diagnosis and management of postoperative pancreatic fistula

“…Recurrences were often treated by "salvage" drainage via the other modality. Hence, endoscopic and percutaneous drainage appeared to be equally effective and complementary interventions for POPF-associated collections [4,29,33,34]. A word of caution: These studies are limited by the retrospective design and the possible selection bias.…”

“…Furthermore, lavage and debridement can be performed as needed. In theory, reintroducing pancreatic fluid from a leak into the gastrointestinal tract is more physiologic and may reduce fluid and enzyme losses [29]. A number of recent retrospective studies compared the drainage of collections associated with POPF using endoscopic and percutaneous modalities.…”

“…Disadvantages of percutaneous drainages include the need of daily care and regular flushing of the catheter to maintain patency, as well as frequent monitoring of fluid output to determine appropriate timing for catheter removal. Furthermore, radiologically guided external drainage may cause localized skin irritation and infections, prolongs the duration of treatment (especially in collections associated with distal pancreatectomy and enucleation), delays oral re-feeding, and implies a longer hospital stay [29]. The use of endoscopic ultrasound (EUS)-guided transmural drainage, initially applied for management of pseudocysts secondary to acute pancreatitis, has grown in frequency to drain collections associated with POPF, after both PD and distal pancreatectomy [30,31].…”