The Effectiveness and Feasibility of Endoscopic Ultrasound-guided Transgastric Drainage of Postoperative Fluid Collections Early After Pancreatic Surgery

Futagawa, Yasuro; Imazu, Hiroo; Mori, Naoki; Kanazawa, Keisuke; Chiba, Masafumi; Furukawa, Kiyonori; Sakamoto, Taro; Shiba, Hiroaki; Yanaga, Katsuhiko

doi:10.1097/sle.0000000000000413

Cited by 21 publications

(30 citation statements)

References 13 publications

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“…Technical success was achieved in all patients across all groups (100%). Clinical success was achieved in 70 patients (93%) after a mean of 2.2 procedures (range, [1][2][3][4][5]. No patients were lost to follow-up.…”

Section: Resultsmentioning

confidence: 95%

“…EUS-guided postoperative fluid collection drainage (EUS-POD) with placement of transmural, plastic, doublepigtail stents and/or lumen-apposing metal stents (LAMSs) has been reported for management of postoperative fluid collections (POFCs). [1][2][3] EUS-POD is often delayed until the POFC has formed a thick wall to optimize the safety of EUS-POD. Percutaneous drainage has been the mainstay of acute POFC management in this setting, although preliminary data suggest that EUS-POD may be as safe and effective as percutaneous drainage.…”

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confidence: 99%

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

Storm

Levy

Kaura

et al. 2020

Gastrointestinal Endoscopy

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Section: Resultsmentioning

confidence: 95%

mentioning

confidence: 99%

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

Storm

Levy

Kaura

et al. 2020

Gastrointestinal Endoscopy

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“…One of the more recent studies was included in subgroups A1 and A2 because it covered the different types of surgical drain management, giving a total of 327 instead of 326 studies. Group A1-B1 included 159 studies (37,489 patients), group A2-B2 included 20 studies (5037 patients), and group C included 148 studies (47,795 patients). A Whipple procedure was reportedly used in 37,170 patients and a pylorus-preserving PD (PPPD) in 21,819, while no data were available for 31,332 patients (34.69%).…”

Section: Resultsmentioning

confidence: 99%

“…1) (Table 3); these procedures have technical success rates of 100% and 92-97%, respectively, but clinical success rates of only 67-77% and 59%, respectively. [36,47,48] Postoperative infections are a major determinant of outcome after PD [49,50], and drain lavage and/or replacement can also help to reduce PO intra-abdominal infection. The earlier and easier approach to POPF treatment by "draining-tracttargeted" management can help explain the different outcomes of the two approaches.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

Pedrazzoli

Brazzale

2020

Langenbecks Arch Surg

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Purpose Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF). Methods PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies. Results Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis. Conclusion Clinically, “draining-targeted” management of POPF should be preferred to “standard” management.

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“…Reported literature evaluating and comparing EUS to PCD shows similar clinical outcomes. [189] The data are limited by small-sized retrospective studies, with no randomized controlled trials to this date. We therefore conducted this meta-analysis to compare EUS-guided management to percutaneous (PCD) management of POPFC.…”

Section: Introductionmentioning

confidence: 99%

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

Mohan¹,

Shakhatreh²,

Dugyala³

et al. 2019

Endosc Ultrasound

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Postoperative pancreatic fluid collection (POPFC) is an important complication following abdominal surgery. POPFC causes significant morbidity and mortality. Management options are time-consuming and severely affect patient's quality of life. Surgical and/or percutaneous drainage (PCD) is the traditional mainstay of treatment. Studies have shown that EUS could have a role to play in the management of POPFC. Data are limited in the comparison of clinical outcomes with EUS as compared to PCD to this end. We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Google Scholar, LILACS, and Web of Science databases (earliest inception through September 2018) to identify studies that reported on the clinical outcomes of EUS and PCD in the management of POPFC. The goals were to estimate and compare the pooled rates of technical success, clinical success, adverse events, and POPFC recurrence with EUS and PCD. A total of 13 studies were included in the analysis. Ten studies (239 patients) used EUS and 6 studies (267 patients) used PCD in the management of POPFC. The pooled rate of clinical success with EUS was 93.2% (95% confidence interval [CI] 88.2–96.2, I2 = 0) and with PCD was 79.8% (95% CI 70–87, I2 = 74). The difference was statistically significant, P = 0.002. Recurrence rate was significantly lower with EUS as compared to PCD (9.4%: 95% CI 5.2–16.5 vs. 25.7%: 95% CI 24.3–41.7; P = 0.02). Pooled rates of technical success and adverse events were similar with EUS and PCD. Our meta-analysis shows that EUS has significantly better clinical outcomes, in terms of clinical success and disease recurrence, in the management of POPFC as compared to PCD.

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The Effectiveness and Feasibility of Endoscopic Ultrasound-guided Transgastric Drainage of Postoperative Fluid Collections Early After Pancreatic Surgery

Abstract: EUS-GD is a safe and useful method for early drainage, which could be a good alternative to PTD.

Cited by 21 publications

References 13 publications

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

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

Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

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

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