Endoscopic ultrasound-guided drainage of abdominal fluid collections after pancreatic surgery: Efficacy and long-term follow-up

Abstract

Background/Purpose: Endoscopic ultrasound-guided drainage (EUS-GD) of postoperative abdominal fluid collections (POFC) following pancreatic surgery is used as an alternative or complement to percutaneous drainage (PD) procedure. The present single-center retrospective study evaluates its efficacy and safety.

Method: We included consecutive cases with POFC treated by EUS-GD between September 2009 and November 2014 in our department. Technical success, long-term clinical success, recurrence rate and need for surgery were analyzed.

Results: 24 procedures in 20 patients (95 % after pancreatic resection) were assessed. Indications for surgery included tumors/lesions located in the pancreas (15/20), chronic pancreatitis (3/20) and duodenal adenoma not completely resectable endoscopically (2/20). EUS-GD was performed within a median of 30 days (IQR: 8.25) for a median fluid collection size of 72.5 mm (IQR: 46.25), requiring a mean of 1.2 sessions with placement of a mean of 2.1 plastic stents (7 Fr/10 Fr) per patient for a mean of 89 days (IQR: 127). Microbiology of aspirated fluid revealed positive cultures in 13 patients, mostly polymicrobial, isolated positive for fungal and 3 multidrug-resistant gram negative (MRGN) in 4 cases. An additional transpapillary drainage was inserted in 1/20 patients. 4/20 patients received PD, mostly before EUS-GD. Technical and clinical success was achieved in 20/20 (100 %) and 18/20 (90 %) patients, respectively, while 2 patients required re-operation. During follow-up (median 630 days after stent removal, range: 45 – 2160), recurrence occurred in 1/18 (5.5 %) patient that was referred for surgery. No death or severe adverse events were noted.

Conclusion: EUS-GD is an effective, minimally invasive and safe method for therapy of POFC after pancreatic surgery offering long-term remission in about 95 % of cases.

Zusammenfassung

Einleitung: Die endosonografisch gesteuerte transmurale Drainage (EUS-GD) von postoperativen Flüssigkeitskollektionen (POFC) wird vermehrt alternativ oder ergänzend zu perkutanen Drainageverfahren durchgeführt. Diese retrospektive Single Center Studie analysiert Effektivität und Sicherheit der Methode nach Pankreaschirurgie.

Methode: Alle konsekutiven postoperativen Verhalte mit klinischer Indikation zur EUS-GD zwischen 09/2009 und 11/2014 wurden eingeschlossen. Analysiert wurden die technische und klinische Erfolgsrate im Langzeitverlauf sowie die Rezidivrate und Re-Operationen.

Ergebnisse: 24 Prozeduren wurden bei 20 Patienten überwiegend nach Pankreasresektionen (95 %) durchgeführt. Zugrundeliegende Operationsindikationen waren Pankreastumore (15/20), chronische Pankreatitis (3/20) und Duodenaladenome (2/20). Die EUD-GD erfolgte im Median 30 Tage postoperativ (IQR 8,25) bei einer medianen POFC Größe von 72,5 mm (IQR 46,25). Pro Patient wurden im Mittel 1,2 Sitzungen mit 2,1 Plastikendoprothesen (7 Fr/10 Fr) durchgeführt, die mittlere Stentliegedauer lag bei 89 Tagen (IQR 127). Die mikrobiologische Untersuchung der Aspirate ergab positive Kulturen bei 13 Patienten meist polymikrobiell, isoliert positiv für Candida oder 3- MRGN in 4/13. Eine zusätzliche nasozystische Spülsonde wurde bei 1/20 Patienten eingelegt, perkutane Drainagen bei 4/20 meist vor der EUS-GD. Der technische und klinische Erfolg lag bei 100 % (20/20) bzw. 90 % (18/20), wobei eine Re-Operation bei 2 Patienten erforderlich war. Im Follow-up (median 630 Tage nach Stententfernung, range: 45 – 2160) trat ein Operationspflichtiges Rezidiv auf (5,5 %, 1/18) auf, keine schweren unerwünschten Ereignisse.

Schlussfolgerung: EUS-GD ist eine effektive, minimal invasive und sichere Methode zur Drainage von POFC. Nach Pankreaschirurgie kommt es in etwa 95 % der Fälle zu Langzeitremission der Verhalte.

Schlüsselwörter

Postoperativer Flüssigkeitsverhalt - EUS-Drainage - Pankreasresektion

Key words

postoperative abdominal fluid collection - drainage - pancreatic resection

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