Author/Authors :
Fujimori, Nao Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Osoegawa, Takashi Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Aso, Akira Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Itaba, Soichi Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Minoda, Yosuke Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Murakami, Masatoshi Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Matsumoto, Kazuhide Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Teramatsu, Katsuhito Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Takamatsu, Yu Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Takaoka, Takehiro Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Oono, Takamasa Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Ihara, Eikichi Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Yoshizumi, Tomoharu Department of Surgery and Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Ohtsuka, Takao Department of Surgery and Oncology - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Nakamura, Masafumi Department of Surgery and Oncology - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan , Ogawa, Yoshihiro Department of Medicine and Bioregulatory Science - Graduate School of Medical Sciences - Kyushu University, Fukuoka, Japan
Abstract :
Background
Endoscopic ultrasound-guided transluminal drainage (EUS-TD) is generally performed 4 weeks after disease onset for evacuating pancreatic fluid collections. However, the optimal timing for conducting the procedure in those diagnosed with postoperative pancreatic fistula (POPF) has not been established. We aimed to elucidate the efficacy and safety of early EUS-TD procedures for treating POPF.
Methods
We retrospectively reviewed patients diagnosed with POPF who underwent EUS-TD in the Kyushu University Hospital between 2008 and 2019. Clinical features were comparatively analyzed between the two patient groups who underwent either early (≤15 days postoperatively) or late (>15 days postoperatively) EUS-TD. Factors prolonging hospital stay were also analyzed using Cox proportional hazard models.
Results
Thirty patients (median age, 64.5 years) were enrolled. The most common initial operation was distal pancreatectomy with splenectomy (60.0%). Median size of POPF was 69.5 (range, 38–145) mm, and median time interval between surgery and EUS-TD was 17.5 (range, 3–232) days. Totally, 47% patients underwent early EUS-TD. Rates of technical success, clinical success, and complications were 100%, 97%, and 6.9%, respectively. No recurrence of POPF occurred during a median follow-up period of 14 months. Clinical characteristics and outcomes were comparable between the early and late drainage patient groups, except for the rates of infection and nonencapsulation of POPF, which were significantly higher in the early drainage group. Performing simultaneous internal and external drainage (hazard ratio (HR): 0.31; 95% confidence interval (CI): 0.11–0.93, p=0.04) and conducting ≥2 treatment sessions (HR: 0.26; 95% CI: 0.08–0.84, p=0.02) were significantly associated with prolonged hospitalization after EUS-TD.
Conclusions
EUS-TD is a safe and effective method for managing POPF, regardless of when it is performed in the postoperative period. Once infected POPF occurs, clinicians should not hesitate to perform EUS-TD even within 15 days of the initial operation.
