Ann Hepatobiliary Pancreat Surg.  2022 Nov;26(4):355-362. 10.14701/ahbps.22-018.

Comparison of endoscopic ultrasound-guided drainage and percutaneous catheter drainage of postoperative fluid collection after pancreaticoduodenectomy

• Woo DH
• Lee JH
• Park YJ
• Lee WH
• Song KB
• Hwang DW
• Kim SC

• KMID: 2536386
• DOI: http://doi.org/10.14701/ahbps.22-018

Abstract

Backgrounds/Aims
Postoperative f luid collection is a common complication of pancreatic resection without clear management guidelines. This study aimed to compare outcomes of endoscopic ultrasound (EUS)-guided trans-gastric drainage and percutaneous catheter drainage (PCD) in patients who experienced this adverse event after pancreaticoduodenectomy (PD).
Methods
Demographic and clinical data and intervention outcomes of 53 patients who underwent drainage procedure (EUS-guided, n = 32; PCD, n = 21) for f luid collection after PD between January 2015 and June 2019 in our tertiary referral center were retrospectively analyzed.
Results
Prior to drainage, 83.0% had leukocytosis and 92.5% presented with one or more of the following signs or symptoms: fever (69.8%), abdominal pain (69.8%), and nausea/vomiting (17.0%). Within 8 weeks of drainage, 77.4% showed a diameter decrease of more than 50% (87.5% in EUS vs. 66.7% in PCD, p = 0.09). Post-procedural intravenous antibiotics were used for an average of 8.1 ± 4.3 days and 12.4 ± 7.4 days for EUS group and PCD group, respectively (p = 0.01). The EUS group had a shorter post-procedural hospital stay than the PCD group (9.8 ± 1.1 vs. 15.8 ± 2.2 days, p < 0.01). However, the two groups showed no statistically significant difference in technical or clinical success rate, reintervention rate, or adverse event rate.
Conclusions
EUS-guided drainage and PCD are both safe and effective methods for managing f luid collection after PD. However, EUS-guided drainage can shorten hospital stay and duration of intravenous antibiotics use.

Keyword

Pancreaticoduodenectomy; Drainage; Pancreas; Endoscopic ultrasonography; Transgastric drainage

Figure

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  Fig. 1 Selection of study population. Of 2,160 patients who underwent pancreaticoduodenectomy (PD) between January 2015 and June 2019, there were 155 cases of postoperative fluid collection (POFC). Among them, 32 cases of percutaneous catheter drainage (PCD) and 21 cases of endoscopic ultrasound (EUS)-guided drainage were selected as our study population. ENCD, endoscopic nasocystic drainage; CGS, cystogastrostomy.

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