Role of Endoscopy in Managing Complications Associated with Pancreaticoduodenectomy: Concise Review of Literature

Abstract

Pancreaticoduodenectomy (PD) is a complex surgery for the management of periampullary tumors. It is associated with significant morbidity and mortality of 20% and 3 to 5% respectively. While early complications like delayed gastric emptying, hemorrhage, and collections are common, late complications like biliary and pancreatic anastomotic stenosis are also known to occur. With the increase in cases of pancreatic and periampullary cancers, there is an upward trend seen even in the rates of surgery. Endoscopy has emerged over the years as a tool for both evaluation and management of various complications. In this narrative review, we aim to provide a primer for gastroenterologists who are likely to be called upon for endoscopic management of post-PD complications.

Keywords

complications - endoscopy - pancreaticoduodenectomy

^* Co-first authors.

Publikationsverlauf

Artikel online veröffentlicht:
29. Juli 2024

• References

• 1 Leichtle SW, Kaoutzanis C, Mouawad NJ. et al. Classic Whipple versus pylorus-preserving pancreaticoduodenectomy in the ACS NSQIP. J Surg Res 2013; 183 (01) 170-176
• 2 Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg 1987; 206 (03) 358-365
• 3 Shrikhande SV, Barreto SG, Somashekar BA. et al. Evolution of pancreatoduodenectomy in a tertiary cancer center in India: improved results from service reconfiguration. Pancreatology 2013; 13 (01) 63-71
• 4 Barakat MT, Adler DG. Endoscopy in patients with surgically altered anatomy. Am J Gastroenterol 2021; 116 (04) 657-665
• 5 Trede M, Schwall G. The complications of pancreatectomy. Ann Surg 1988; 207 (01) 39-47
• 6 Rumstadt B, Schwab M, Korth P, Samman M, Trede M. Hemorrhage after pancreatoduodenectomy. Ann Surg 1998; 227 (02) 236-241
• 7 Reber PU, Baer HU, Patel AG, Triller J, Büchler MW. Life-threatening upper gastrointestinal tract bleeding caused by ruptured extrahepatic pseudoaneurysm after pancreatoduodenectomy. Surgery 1998; 124 (01) 114-115
• 8 Balachandran P, Sikora SS, Raghavendra Rao RV, Kumar A, Saxena R, Kapoor VK. Haemorrhagic complications of pancreaticoduodenectomy. ANZ J Surg 2004; 74 (11) 945-950
• 9 Yekebas EF, Wolfram L, Cataldegirmen G. et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 2007; 246 (02) 269-280
• 10 Limongelli P, Khorsandi SE, Pai M. et al. Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis. Arch Surg 2008; 143 (10) 1001-1007 , discussion 1007
• 11 Katz S, Lazar L, Rathaus V, Erez I. Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma?. J Pediatr Surg 1996; 31 (05) 649-651
• 12 Feng J, Chen YL, Dong JH, Chen MY, Cai SW, Huang ZQ. Post-pancreaticoduodenectomy hemorrhage: risk factors, managements and outcomes. Hepatobiliary Pancreat Dis Int 2014; 13 (05) 513-522
• 13 Zhou TY, Sun JH, Zhang YL. et al. Post-pancreaticoduodenectomy hemorrhage: DSA diagnosis and endovascular treatment. Oncotarget 2017; 8 (43) 73684-73692 [published correction appears in Oncotarget 2018;9(20):15436]
• 14 Habib JR, Gao S, Young AJ. et al. Incidence and contemporary management of delayed bleeding following pancreaticoduodenectomy. World J Surg 2022; 46 (05) 1161-1171
• 15 Giuliano K, Ejaz A, He J. Technical aspects of pancreaticoduodenectomy and their outcomes. Chin Clin Oncol 2017; 6 (06) 64
• 16 Nakamura T, Ambo Y, Noji T. et al. Reduction of the incidence of delayed gastric emptying in side-to-side gastrojejunostomy in subtotal stomach-preserving pancreaticoduodenectomy. J Gastrointest Surg 2015; 19 (08) 1425-1432
• 17 Kim DK, Hindenburg AA, Sharma SK. et al. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy?. Ann Surg Oncol 2005; 12 (03) 222-227
• 18 Eisenberg JD, Rosato EL, Lavu H, Yeo CJ, Winter JM. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg 2015; 19 (09) 1572-1580
• 19 Wente MN, Bassi C, Dervenis C. et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142 (05) 761-768
• 20 Patel AG, Toyama MT, Kusske AM, Alexander P, Ashley SW, Reber HA. Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better?. Arch Surg 1995; 130 (08) 838-842 , discussion 842–843
• 21 Lin PW, Lin YJ. Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy. Br J Surg 1999; 86 (05) 603-607
• 22 Qu H, Sun GR, Zhou SQ, He QS. Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis. Eur J Surg Oncol 2013; 39 (03) 213-223
• 23 Yeo CJ, Barry MK, Sauter PK. et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg 1993; 218 (03) 229-237 , discussion 237–238
• 24 Calogero, Cristina, Chalikonda, et al. Endoscopic management of post-pancreaticoduodenectomy delayed gastric emptying. Am J Gastroenterol 2020; 115 (02) S259
• 25 Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 1999; 229 (05) 693-698 , discussion 698–700
• 26 Balcom IV JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001; 136 (04) 391-398
• 27 Briggs CD, Mann CD, Irving GR. et al. Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 2009; 13 (06) 1129-1137
• 28 Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K. Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 2004; 18 (03) 402-406
• 29 Pannegeon V, Pessaux P, Sauvanet A, Vullierme MP, Kianmanesh R, Belghiti J. Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg 2006; 141 (11) 1071-1076 , discussion 1076
• 30 Harnoss JC, Ulrich AB, Harnoss JM, Diener MK, Büchler MW, Welsch T. Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery 2014; 155 (01) 47-57
• 31 Bassi C, Dervenis C, Butturini G. et al; International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138 (01) 8-13
• 32 Bassi C, Marchegiani G, Dervenis C. et al; International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017; 161 (03) 584-591
• 33 Kwon YM, Gerdes H, Schattner MA. et al. Management of peripancreatic fluid collections following partial pancreatectomy: a comparison of percutaneous versus EUS-guided drainage. Surg Endosc 2013; 27 (07) 2422-2427
• 34 Téllez-Ávila F, Carmona-Aguilera GJ, Valdovinos-Andraca F. et al. Postoperative abdominal collections drainage: percutaneous versus guided by endoscopic ultrasound. Dig Endosc 2015; 27 (07) 762-766
• 35 Fotoohi M, D'Agostino HB, Wollman B, Chon K, Shahrokni S, vanSonnenberg E. Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: role of cause and severity of pancreatitis. Radiology 1999; 213 (02) 573-578
• 36 Azeem N, Baron TH, Topazian MD, Zhong N, Fleming CJ, Kendrick ML. Outcomes of endoscopic and percutaneous drainage of pancreatic fluid collections arising after pancreatic tail resection. J Am Coll Surg 2012; 215 (02) 177-185
• 37 Al Efishat M, Attiyeh MA, Eaton AA. et al. Endoscopic versus percutaneous drainage of post-operative peripancreatic fluid collections following pancreatic resection. HPB (Oxford) 2019; 21 (04) 434-443
• 38 Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008; 68 (06) 1102-1111
• 39 Woo DH, Lee JH, Park YJ. et al. Comparison of endoscopic ultrasound-guided drainage and percutaneous catheter drainage of postoperative fluid collection after pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg 2022; 26 (04) 355-362
• 40 Ramouz A, Shafiei S, Ali-Hasan-Al-Saegh S. et al. Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery. Surg Endosc 2022; 36 (06) 3708-3720
• 41 Sundaram S, Giri S, Binmoeller K. Lumen-apposing metal stents: a primer on indications and technical tips. Indian J Gastroenterol 2024;
• 42 Koduri KK, Jagtap N, Lakhtakia S. et al. Biflanged metal stents versus plastic stents in the endoscopic ultrasound-guided drainage of walled-off necrosis: a randomized controlled trial. Endoscopy 2024;
• 43 Giri S, Harindranath S, Afzalpurkar S, Angadi S, Sundaram S. Does a coaxial double pigtail stent reduce adverse events after lumen apposing metal stent placement for pancreatic fluid collections? A systematic review and meta-analysis. Ther Adv Gastrointest Endosc 2023; 16: 26 317745231199364
• 44 Bang JY, Hasan M, Navaneethan U, Hawes R, Varadarajulu S. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2017; 66 (12) 2054-2056
• 45 House MG, Cameron JL, Schulick RD. et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243 (05) 571-576 , discussion 576–578
• 46 Javed AA, Mirza MB, Sham JG. et al. Postoperative biliary anastomotic strictures after pancreaticoduodenectomy. HPB (Oxford) 2021; 23 (11) 1716-1721
• 47 Guo W, Ye X, Li J. et al. Comparison of surgical outcomes among open, laparoscopic, and robotic pancreatoduodenectomy: a single-center retrospective study. BMC Surg 2022; 22 (01) 348
• 48 Mucci-Hennekinne S, Brachet D, Clouston H, Pessaux P, Hamy A, Arnaud JP. Management of a stenotic pancreatico-digestive tract anastomosis following pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 2007; 14 (05) 514-517
• 49 Amano H, Takada T, Ammori BJ. et al. Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study. Hepatogastroenterology 1998; 45 (24) 2382-2387
• 50 Nennstiel S, Weber A, Frick G. et al. Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. J Clin Gastroenterol 2015; 49 (09) 764-770
• 51 Skinner M, Popa D, Neumann H, Wilcox CM, Mönkemüller K. ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy 2014; 46 (07) 560-572
• 52 Pal P, Kulkarni SA, Chaudhari H. et al. Single-balloon enteroscopy—guided ERCP in surgically altered anatomy is safe and highly effective: results from a prospective study. J Dig Endosc 2019; 10 (04) 221-227
• 53 Garcés-Durán R, Monino L, Deprez PH, Piessevaux H, Moreels TG. Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants: lessons learned from single-balloon enteroscopy-assisted ERCP. Hepatobiliary Pancreat Dis Int 2024; 23 (05) 509-514
• 54 Krutsri C, Kida M, Yamauchi H, Iwai T, Imaizumi H, Koizumi W. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol 2019; 25 (26) 3313-3333
• 55 Sundaram S, Kale A. Endoscopic ultrasound guided biliary drainage in surgically altered anatomy: a comprehensive review of various approaches. World J Gastrointest Endosc 2023; 15 (03) 122-132
• 56 Nakai Y, Kogure H, Isayama H, Koike K. Endoscopic ultrasound-guided biliary drainage for benign biliary diseases. Clin Endosc 2019; 52 (03) 212-219
• 57 Jovani M, Ichkhanian Y, Vosoughi K, Khashab MA. EUS-guided biliary drainage for postsurgical anatomy. Endosc Ultrasound 2019; 8 (Suppl. 01) S57-S66
• 58 Katanuma A, Hayashi T, Kin T. et al. Interventional endoscopic ultrasonography in patients with surgically altered anatomy: techniques and literature review. Dig Endosc 2020; 32 (02) 263-274
• 59 Dhir V, Artifon EL, Gupta K. et al. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: choice of access route, direction of stent insertion, and drainage route. Dig Endosc 2014; 26 (03) 430-435
• 60 Khashab MA, Valeshabad AK, Modayil R. et al. EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc 2013; 78 (05) 734-741
• 61 Martin A, Kistler CA, Wrobel P, Yang JF, Siddiqui AA. Endoscopic ultrasound-guided pancreaticobiliary intervention in patients with surgically altered anatomy and inaccessible papillae: a review of current literature. Endosc Ultrasound 2016; 5 (03) 149-156
• 62 Iwashita T, Nakai Y, Hara K, Isayama H, Itoi T, Park DH. Endoscopic ultrasound-guided antegrade treatment of bile duct stone in patients with surgically altered anatomy: a multicenter retrospective cohort study. J Hepatobiliary Pancreat Sci 2016; 23 (04) 227-233
• 63 Khashab MA, El Zein MH, Sharzehi K. et al. EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study. Endosc Int Open 2016; 4 (12) E1322-E1327
• 64 Jamwal KD, Sharma A, Padhan RK, Sharma MK. Outcomes of endoscopic biliary drainage in postsurgical anatomy using endoscopic ultrasound and enteroscopy: a comparative study. J Dig Endosc 2023; 14 (03) 127-134
• 65 Siripun A, Sripongpun P, Ovartlarnporn B. Endoscopic ultrasound-guided biliary intervention in patients with surgically altered anatomy. World J Gastrointest Endosc 2015; 7 (03) 283-289
• 66 Minaga K, Takenaka M, Ogura T. et al. Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study. Therap Adv Gastroenterol 2020; 13: 17 56284820930964
• 67 Shah JN, Marson F, Weilert F. et al. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc 2012; 75 (01) 56-64
• 68 Tyberg A, Sharaiha RZ, Kedia P. et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc 2017; 85 (01) 164-169
• 69 Kinney TP, Li R, Gupta K. et al. Therapeutic pancreatic endoscopy after Whipple resection requires rendezvous access. Endoscopy 2009; 41 (10) 898-901
• 70 Chen YI, Levy MJ, Moreels TG. et al. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc 2017; 85 (01) 170-177
• 71 Kogure H, Sato T, Nakai Y. et al. Endoscopic management of pancreatic diseases in patients with surgically altered anatomy: clinical outcomes of combination of double-balloon endoscopy- and endoscopic ultrasound-guided interventions. Dig Endosc 2021; 33 (03) 441-450
• 72 Chandan S, Mohan BP, Khan SR. et al. Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): a systematic review and meta-analysis of 714 patients. Endosc Int Open 2020; 8 (11) E1664-E1672