Pancreatic trauma: a less aggressive approach is safe

Abstract

used EUSE to assess pancreatic texture at the resection margin and its relation to pancreatic fibrosis and POPF. Methods: Between June 2012 and December 2013 all patients who underwent EUS for diagnosis/assessment of resectability had an EUSE done. An area (A) in the neck/body (intended resection site) and another area (B) in the peripancreatic soft tissue were analysed. The strain ratio (B/A) was used to assess pancreatic texture. The main pancreatic duct (MPD) size was measured and the degree of fibrosis at the resected pancreatic margin was assessed histologically. Results: Thirty-four patients were studied. A strain ratio of 2.75 defined normal/soft and >2.75 as firm/very firm pancreas. Nine had clinically relevant POPF (26.5%; ISGPF grades B: 6 and C: 3). A higher proportion of patients with strain ratio 2.75 developed POPF (34.7% vs. 9.1%; p = 0.21) and had a sensitivity and negative predictive value of 88.9% and 91%, respectively Patients with no/minimal fibrosis had a higher rate of POPF(32% vs. 11.1%; p = 0.39). Strain ratio correlated well with pancreatic texture, fibrosis grade and MPD size (p < 0.001). POPF occurred more frequently in those with a higher mean BMI (22.5 AE 3.6 vs. 20.1 AE 2.7; P = 0.04). Strain ratio had an accuracy, sensitivity, specificity, PPV and NPV of 88.2%, 89%, 88%, 72.7% and 95%, respectively for assessment of fibrosis. Conclusions: EUSE of the pancreas did not predict POPF but correlated well with pancreatic texture, degree of pancreatic fibrosis and MPD size.