Introduction
Post-operative pancreatic fluid collections (POPFCs) are common adverse events after pancreatic surgery and may need interventions. Endoscopic ultrasound (EUS)-guided drainage for POPFCs is increasingly reported, but its appropriate timing has not been fully elucidated.
Aims & Methods
The aim of this meta-analysis was to evaluate treatment outcomes of POPFCs according to the timing of EUS-guided drainage. Using PubMed, Embase, Web of Science, and the Cochrane database, we identified clinical studies published until December 2022 with data comparing outcomes of early and delayed EUS-guided drainage for POPFCs. We pooled data on adverse events (AEs), mortality, and technical and clinical success rates, using the random-effects model.
Results
From 1,415 papers identified in the initial literature search, we identified 6 retrospective studies, including 128 and 107 patients undergoing early and delayed EUS-guided drainage for POPFCs. The threshold of early and delayed drainage ranged from 14 to 30 days. Distal pancreatectomy was the major cause of POPFCs, ranging from 44 to 100%. Reported AE rates of EUS-guided drainage of POPFCs ranged from 4% to 46%, and the pooled odds ratio (OR) for adverse events was 0.81 (95% confidence interval [CI], 0.40-1.64, P = 0.55) comparing early to delayed drainage. There was no evidence on heterogeneity between the studies (Pheterogeneity = 0.93 and I2 = 0%). There was no procedure-related mortality, and technical success was achieved in all cases. Clinical success rates were reported as 90 to 97% and were comparable between early and delayed drainage groups with a pooled OR of 0.60 (95% CI, 0.20-1.83, P = 0.37).
Clinical outcomes of early and delayed EUS-guided drainage for postoperative pancreatic fluid collection.
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Study
| Early/Delayed, n | Technical success(%) | Clinical success(%) | Adverse event(%) | Bleeding(%) | Infection(%) | Stent migration(%) |
Varadarajulu
| 4/6 | 100/100 | 100/83 | 0/0 | 0/0 | 0/0 | 0/17 |
Tilara
| 17/14 | 100/100
| 100/100 | 6/7 | 6/7 | 0/0 | 0/0 |
Caillol
| 22/19 | 100/100 | 86/100 | 45/47 | 27/16 | 14/21 | 0/11 |
Storm
| 42/33 | 100/100 | 93/94 | 21/30 | 5/6 | 0/3 | 0/3 |
Fujimori
| 14/16 | 100/100 | 93/100 | 7/6 | 7/6 | 0/0 | 0/0 |
Oh
| 29/19 | 100/100 | 97/95 | 7/0 | 7/0 | 0/0 | 0/0 |
Conclusion
POPFCs can be managed by early EUS-guided drainage without an increase in AEs.
References
1. Varadarajulu S, Trevino JM, Christein JD. EUS for the management of peripancreatic fluid collections after distal pancreatectomy. Gastrointest Endosc 2009;70:1260-5.
2. Tilara A, Gerdes H, Allen P, et al. Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections. J Am Coll Surg 2014;218:33-40.
3. Caillol F, Godat S, Turrini O, et al. Fluid collection after partial pancreatectomy: EUS drainage and long-term follow-up. Endoscopic Ultrasound 2019;8:91-8.
4. Storm AC, Levy MJ, Kaura K, et al. Acute and early EUS-guided transmural drainage of symptomatic postoperative fluid collections. Gastrointest Endosc 2020;91:1085-91.e1.
5. Fujimori N, Osoegawa T, Aso A, et al. Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula. Canadian Journal of Gastroenterology and Hepatology 2021;2021.
6. Oh D, Lee H, Song TJ, et al. Effectiveness of early endoscopic ultrasound-guided drainage for postoperative fluid collection. Surg Endosc 2022;36:135-42.
Disclosure
Y.N. received research grants from Boston Scientific Japan, HOYA Corporation, and honoraria from Boston Scientific Japan, Fujifilm Corporation, Olympus Corporation. H.I. received research grants from Boston Scientific Japan, Fujifilm Corporation, Fujifilm Health Care Corporation, Gadelius Medical KK, Zeon Medical Inc., and honoraria from Boston Scientific Japan, Fujifilm Corporation, Taewoong Medical Devices, Olympus Corporation, Century Medical,Inc. and Cook Medical Japan G.K. Y.I. received honoraria from Gadelius Medical KK and Medicos Hirata.