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Endoscopic ultrasound-guided versus percutaneous drainage for the management of post-operative fluid collections after distal pancreatectomy

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Abstract

Background

Post-operative pancreatic fluid collections (POPFCs) can be drained using percutaneous or endoscopic approaches. The primary aim of this study was to compare rates of clinical success between endoscopic ultrasound-guided drainage (EUSD) with percutaneous drainage (PTD) in the management of symptomatic POPFCs after distal pancreatectomy. Secondary outcomes included technical success, total number of interventions, time to resolution, rates of adverse events (AEs), and POPFC recurrence.

Methods

Adults who underwent distal pancreatectomy from January 2012 to August 2021 and developed symptomatic POPFC in the resection bed were retrospectively identified from a single academic center database. Demographic data, procedural data, and clinical outcomes were abstracted. Clinical success was defined as symptomatic improvement and radiographic resolution without requiring an alternate drainage modality. Quantitative variables were compared using a two-tailed t-test and categorical data were compared using Chi-squared or Fisher’s exact tests.

Results

Of 1046 patients that underwent distal pancreatectomy, 217 met study inclusion criteria (median age 60 years, 51.2% female), of whom 106 underwent EUSD and 111 PTD. There were no significant differences in baseline pathology and POPFC size. PTD was generally performed earlier after surgery (10 vs. 27 days; p < 0.001) and more commonly in the inpatient setting (82.9% vs. 49.1%; p < 0.001). EUSD was associated with a significantly higher rate of clinical success (92.5% vs. 76.6%; p = 0.001), fewer median number of interventions (2 vs. 4; p < 0.001), and lower rate of POPFC recurrence (7.6% vs. 20.7%; p = 0.007). AEs were similar between EUSD (10.4%) and PTD (6.3%, p = 0.28), with approximately one-third of EUSD AEs due to stent migration.

Conclusion

In patients with POPFCs after distal pancreatectomy, delayed drainage with EUSD was associated with higher rates of clinical success, fewer interventions, and lower rates of recurrence than earlier drainage with PTD.

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  1. Delvise T. Fogwe and Jad P. AbiMansour have contributed equally.

Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, USA

    Delvise T. Fogwe

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Jad P. AbiMansour, Michael J. Levy, Andrew C. Storm, Ryan J. Law, Eric J. Vargas, John A. Martin, Aliana M. Bofill-Garcia, Barham K. Abu Dayyeh & Vinay Chandrasekhara

  3. Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, USA

    Mark J. Truty, Sean P. Cleary & Michael L. Kendrick

  4. Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, USA

    Chad J. Fleming & James C. Andrews

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Correspondence to Vinay Chandrasekhara.

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Disclosures

Dr. Barham K. Abu Dayyeh is a consultant and grant or research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific, consultant roles with Endogenex, Endo-TAGSS, Metamodix, and BFKW. Dr. Barham K. Abu Dayyeh also has speaker roles with Olympus, Johnson and Johnson; speaker and grant or research support from Medtronic, Endogastric solutions. Dr. Barham K. Abu Dayyeh receives research support from Apollo Endosurgery and Spatz Medical. Dr. Vinay Chandrasekhara is consultant for Covidien LP and Boston Scientific and a shareholder in Nevakar, Inc. Dr. Ryan J. Law receives royalties from UpToDate and is a consultant for ConMed and Medtronic. Dr. Andrew C. Storm received research support from Apollo Endosurgery and Boston Scientific and is a consultant for Apollo Endosurgery and consultant for Erbe. B. K. Dr. Jad P. Ambimansour, Dr. Aliana M. Bofill-Garcia, Dr. Sean P. Cleary, Dr. Chad J. Fleming, Dr. Michael L. Kendrick, Dr. James C Andrews, Dr. Michael J. Levy, Dr. John A. Martin, Dr. Mark J. Truty, Dr. Dr. Eric J. Vargas, and Dr. Delvise T. Fogwe have no conflict of interests.

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Fogwe, D.T., AbiMansour, J.P., Truty, M.J. et al. Endoscopic ultrasound-guided versus percutaneous drainage for the management of post-operative fluid collections after distal pancreatectomy. Surg Endosc 37, 6922–6929 (2023). https://doi.org/10.1007/s00464-023-10188-6

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