EUS-guided drainage in the management of postoperative pancreatic leaks and fistulas (with video)

Jürgensen, Christian; Distler, Marius; Arlt, Alexander; Brückner, Stefan; Ellrichmann, Mark; Matthes, Katja; Ludwig, Marleen; Sulk, Stephan; Romberg, Laura; Zeißig, Sebastian; Schafmayer, Clemens; Hinz, Sebastian; Welsch, Thilo; Bahra, Marcus; Aselmann, H.; Weitz, Jürgen; Klein, Fritz; Becker, Thomas; Hampe, Jochen

doi:10.1016/j.gie.2018.08.046

Cited by 33 publications

(36 citation statements)

References 18 publications

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“…Thirteen studies were included in the final analysis. [1789232425262728293031] Out of the 13 studies, 10 studies provided data on the use of EUS in POPFC management (EUS-POPFC)[18924252627282930] and 6 provided data on the use of PCD in POPFC (PCD-POPFC). [789232731]…”

Section: Resultsmentioning

confidence: 99%

“…All 13 studies were of retrospective nature. [1789232425262728293031] Out of the included 13 studies, none were population based. Two studies[2728] were from multicenter data and rest were from single center.…”

Section: Resultsmentioning

confidence: 99%

“…[1789232425262728293031] Out of the included 13 studies, none were population based. Two studies[2728] were from multicenter data and rest were from single center. Four studies had more than 40 patients,[7242731] seven studies had 20–39 patients,[23252627282930] and the rest had <20 patients in their study group.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies[2728] were from multicenter data and rest were from single center. Four studies had more than 40 patients,[7242731] seven studies had 20–39 patients,[23252627282930] and the rest had <20 patients in their study group. All studies reported adequately on the technical success and clinical success outcomes.…”

Section: Resultsmentioning

confidence: 99%

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EUS versus percutaneous management of postoperative pancreatic fluid collection: A systematic review and meta-analysis

Mohan¹,

Shakhatreh²,

Dugyala³

et al. 2019

Endosc Ultrasound

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Postoperative pancreatic fluid collection (POPFC) is an important complication following abdominal surgery. POPFC causes significant morbidity and mortality. Management options are time-consuming and severely affect patient's quality of life. Surgical and/or percutaneous drainage (PCD) is the traditional mainstay of treatment. Studies have shown that EUS could have a role to play in the management of POPFC. Data are limited in the comparison of clinical outcomes with EUS as compared to PCD to this end. We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Google Scholar, LILACS, and Web of Science databases (earliest inception through September 2018) to identify studies that reported on the clinical outcomes of EUS and PCD in the management of POPFC. The goals were to estimate and compare the pooled rates of technical success, clinical success, adverse events, and POPFC recurrence with EUS and PCD. A total of 13 studies were included in the analysis. Ten studies (239 patients) used EUS and 6 studies (267 patients) used PCD in the management of POPFC. The pooled rate of clinical success with EUS was 93.2% (95% confidence interval [CI] 88.2–96.2, I2 = 0) and with PCD was 79.8% (95% CI 70–87, I2 = 74). The difference was statistically significant, P = 0.002. Recurrence rate was significantly lower with EUS as compared to PCD (9.4%: 95% CI 5.2–16.5 vs. 25.7%: 95% CI 24.3–41.7; P = 0.02). Pooled rates of technical success and adverse events were similar with EUS and PCD. Our meta-analysis shows that EUS has significantly better clinical outcomes, in terms of clinical success and disease recurrence, in the management of POPFC as compared to PCD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

EUS versus percutaneous management of postoperative pancreatic fluid collection: A systematic review and meta-analysis

Mohan¹,

Shakhatreh²,

Dugyala³

et al. 2019

Endosc Ultrasound

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“…Pancreatic leaks and fistulas can also be present in up to 20% of patients with partial pancreatic resection [23]. EUS-PDD can be successfully performed in these cases to avoid difficult and risky surgical interventions [30,43].…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

EUS-Guided Pancreatic Duct Cannulation

Campos¹,

Bruno²

2020

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Endoscopic ultrasound-guided pancreatic duct drainage is an emerging endoscopic procedure to provide access to and enable interventions in the main pancreatic duct for patients with failed ERCP or with surgically altered anatomy. It is now considered a valid alternative to percutaneous or surgical interventions. Nonetheless, it is technically demanding and carries a notable risk for complications. Appropriate patient selection, careful evaluation of the indication and contraindications, and execution by highly experienced endoscopists are important prerequisites to ensure optimal outcomes.

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Impact of endoscopic ultrasound‐guided transmural drainage for postoperative pancreatic fistula after pancreatic surgery

et al. 2023

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ObjectivesPostoperative pancreatic fistula (POPF) is a major cause of morbidity after pancreatic surgery. Recently, endoscopic ultrasound‐guided transmural drainage (EUS‐TD) has been widely used to manage pancreatic pseudocysts after acute pancreatitis. Several studies have reported the effectiveness of EUS‐TD for POPF, although there is insufficient evidence regarding the performance of EUS‐TD for POPF. We herein report on the safety, efficacy, and appropriate timing of EUS‐TD for POPF compared with conventional percutaneous intervention.MethodsEight patients who underwent EUS‐TD of POPF and 36 patients who underwent percutaneous intervention were retrospectively enrolled. Clinical outcomes, including technical success, clinical success, and complications, were analyzed among the two groups.ResultsIn terms of clinical outcomes between the EUS‐TD and percutaneous intervention groups, significant differences were observed in the number of interventions (1 vs. 4, p = 0.011), period of clinical success (6 days vs. 11 days, p = 0.001), incidence of complications (0 vs. 3, p = 0.021), postoperative hospital stays (27 days vs. 34 days, p = 0.027), and recurrence of POPF (0 vs. 5, p = 0.001).ConclusionsEUS‐TD for POPF appears to be safe and technically feasible. This approach should be considered a therapeutic option in patients with POPF after pancreatic surgery.

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EUS-guided drainage in the management of postoperative pancreatic leaks and fistulas (with video)

Cited by 33 publications

References 18 publications

EUS versus percutaneous management of postoperative pancreatic fluid collection: A systematic review and meta-analysis

EUS versus percutaneous management of postoperative pancreatic fluid collection: A systematic review and meta-analysis

EUS-Guided Pancreatic Duct Cannulation

Impact of endoscopic ultrasound‐guided transmural drainage for postoperative pancreatic fistula after pancreatic surgery

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