EUS for the management of peripancreatic fluid collections after distal pancreatectomy

• Published in: Gastrointestinal endoscopy 2009-12, Vol.70 (6), p.1260-1265
• Main Authors: Varadarajulu, Shyam, MD, Trevino, Jessica M., MD, Christein, John D., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Digestive system. Abdomen; Drainage - methods; Endoscopy; Endosonography; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Pancreas; Pancreatectomy; Postoperative Complications - therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.06.007

Background Peripancreatic fluid collections (PFCs) are a common complication after distal pancreatectomy and are usually managed by percutaneous drainage. The role of EUS in the management of postoperative PFCs has not been previously reported. Objective To evaluate the role of EUS in the management of PFCs after distal pancreatectomy. Study Design Case series. Setting Academic tertiary referral center. Patients Symptomatic patients with PFCs after a distal pancreatectomy. Interventions At EUS, the PFCs were accessed transgastrically by using a 19-gauge FNA needle and after passage of a 0.035-inch guidewire; sequential dilation of the transgastric tract was performed up to 8 mm and multiple 7F or 10F double-pigtail stents were deployed. Nasocystic drainage catheters were deployed in those with poor drainage at the time of endoscopy. Main Outcome Measurements To evaluate the technical and treatment success and safety profile of the EUS-based approach for management of PFCs after distal pancreatectomy. Results Ten patients (6 men, 4 women; mean age, 56.8 years [range 20-76 years]) underwent EUS-guided drainage of PFCs after distal pancreatectomy over a 30-month period. Indications for distal pancreatectomy were neuroendocrine tumor in 5 patients, focal chronic pancreatitis in 2, cyst neoplasm in 1, adenocarcinoma in 1, and trauma in 1. The mean size of the PFCs (largest dimension) was 91.4 mm (range 45-140 mm). EUS-guided drainage was technically successful in all 10 patients; 1 patient underwent EUS-guided drainage of 2 large noncommunicating PFCs in the same endoscopy session. Treatment was successful in 9 (90%) of 10 patients; 1 patient had persistent symptoms requiring reoperation. No procedural complications were encountered. At a mean follow-up of 151 days (range 96-280 days), all 9 patients were doing well without any evidence of symptom recurrence. Limitations Small number of patients and lack of a comparative treatment group. Conclusions EUS-guided drainage is a minimally invasive, safe, and highly effective technique for the management of symptomatic PFC after distal pancreatectomy.