The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery

Ong, Lester Wei Lin; Chong, Charing Ching‐Ning

doi:10.3390/gastroent12040041

Cited by 3 publications

(2 citation statements)

References 35 publications

(106 reference statements)

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“…In addition, operative outcomes and most postoperative complications were similar between the IS and FCSEMS groups, except for pancreatic fistula. Pancreatic fistula is a cautionary complication because it can lead to more severe consequences such as pseudoaneurysms, bleeding, tissue necrosis, and abscess formation [ 32 ]. Watanabe et al reported a general incidence of pancreatic fistula (grade B/C on International Study Group of Pancreatic Surgery) rate of 10.7% after PHCC surgery, which was closely related to a specific surgical maneuver intrapancreatic duct resection [ 31 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of an Inside Stent and a Fully Covered Self-Expandable Metallic Stent as Preoperative Biliary Drainage for Patients with Resectable Perihilar Cholangiocarcinoma

Mori

Kawashima

Ohno

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background. There is a need for a more tolerable preoperative biliary drainage (PBD) method for perihilar cholangiocarcinoma (PHCC). In recent years, inside stents (ISs) have attracted attention as a less suffering PBD method. Few studies have compared IS with a fully covered self-expandable metallic stent (FCSEMS) as PBD for resectable PHCC. The aim of this study is to compare them. Methods. This study involved 86 consecutive patients (IS: 51; FCSEMS: 35). The recurrent biliary obstruction (RBO) rate until undergoing surgery or being diagnosed as unresectable, time to RBO, factors related to RBO, incidence of adverse events related to endoscopic retrograde cholangiography, and postoperative complications associated with each stent were evaluated retrospectively. Results. There was no significant difference between the two groups in the incidence of adverse events after stent insertion. After propensity score matching, the mean (SD) time to RBO was 37.9 (30.2) days in the IS group and 45.1 (35.1) days in the FCSEMS group, with no significant difference ( P = 0.912 , log-rank test). A total of 7/51 patients in the IS group and 3/35 patients in the FCSEMS group developed RBO. The only risk factor for RBO was bile duct obstruction of the future excisional liver lobe(s) due to stenting (HR 29.8, P = 0.008 ) in the FCSEMS group, but risk factors could not be indicated in the IS group. There was no significant difference in the incidence of bile leakage or liver failure. In contrast, pancreatic fistula was significantly more common in the FCSEMS group (13/23 patients) than in the IS group (3/28 patients) ( P < 0.001 ), especially in patients who did not undergo pancreatectomy ( P = 0.001 ). Conclusions. As PBD, both IS and FCSEMS achieved low RBO rates. Compared with FCSEMS, IS shows no difference in RBO rate, is associated with fewer postoperative complications, and is considered an appropriate means of PBD for resectable PHCC. This trail is registered with UMIN000025631.

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Section: Discussionmentioning

confidence: 99%

Comparison of an Inside Stent and a Fully Covered Self-Expandable Metallic Stent as Preoperative Biliary Drainage for Patients with Resectable Perihilar Cholangiocarcinoma

Mori

Kawashima

Ohno

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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“…The endoscopic ultrasound-guided drainage showed a higher clinical success rate compared to percutaneous drainage. However, data on endoscopic ultrasound-guided drainage with LAMS were limited [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Drainage of Complex Walled-Off Pancreatic Fluid Collections in LAMS Era: A Multicenter Study

Luangsukrerk

Harinwan

Khoo

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background. The lumen-apposing metal stent (LAMS) has been increasingly used for EUS-guided drainage of symptomatic walled-off pancreatic fluid collection (WOPFC) in recent years. Nevertheless, some WOPFCs may require additional drainage methods including another LAMS as a result of complexity of the lesions. This current study aimed to compare clinical parameters of patients with complex WOPFC requiring LAMS with additional methods (complex WOPFC: group A) versus single LAMS alone (noncomplex WOPFC; group B). Method. Medical records of patients with complex (group A) versus noncomplex WOPFCs (group B) were reviewed and compared in three centers in Thailand and Malaysia, between January 2016 to December 2020. Result. 31 patients with WOPFCs were recruited. 6 of 31 (19%) patients were in group A. Multivariate analysis showed that the maximal diameter of WOPFCs in group A was significantly larger than that of group B (18 ± 6 versus 13 ± 3 cm in diameter, respectively, p = 0.021). Solid component proportion was higher in group A versus B (35.8% versus 17.8%, respectively, p = 0.025). The prevalence of pancreatic duct leakage was significantly higher in group A (67% versus 20%, p = 0.23). The need of direct endoscopic necrosectomy (DEN) and the number of DEN sessions were higher in group A versus B (100% vs. 48%, p = 0.020 and 3.5 vs 0 p = 0.031, respectively). Conclusions. Complex WOPFC had larger diameter of lesions, higher proportion of solid component, higher prevalence of pancreatic duct leakage, and higher number of DEN is required than group noncomplex lesions. Trial Registration. This trial is registered with TCTR20180223004.

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The contribution of EUS to the management of endoscopic and surgical complications

Tehami,

Kaushal,

Maher

2024

Best Practice & Research Clinical Gastroenterology

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The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery

Cited by 3 publications

References 35 publications

Comparison of an Inside Stent and a Fully Covered Self-Expandable Metallic Stent as Preoperative Biliary Drainage for Patients with Resectable Perihilar Cholangiocarcinoma

Comparison of an Inside Stent and a Fully Covered Self-Expandable Metallic Stent as Preoperative Biliary Drainage for Patients with Resectable Perihilar Cholangiocarcinoma

Drainage of Complex Walled-Off Pancreatic Fluid Collections in LAMS Era: A Multicenter Study

The contribution of EUS to the management of endoscopic and surgical complications

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