Abstract:
Background:Postoperative pancreatic collection (POPC) is a frequent complication after pancreatectomy. Although percutaneous drainage (PD) has been the treatment of choice for POPC with encapsulation, endoscopic ultrasound-guided transmural drainage (EUS-TD) was recently reported effective for this condition. The main aim of this retrospective study was to compare EUS-TD and PD in terms of effectiveness and safety as the first procedure in patients with noncapsulated POPC. Methods:Consecutive patients who underwent pancreatectomy and developed noncapsulated POPC requiring EUS-TD or PD between April 2003 and May 2018 were enrolled. Noncapsulated POPC was defined as pancreatic collection appearing within 28 days postoperatively and lacking a thick encapsulating inflammatory wall on contrast-enhanced computed tomography. The effectiveness of drainage was compared between the two groups before and after propensity-score matching of patient characteristics. Outcomes of interest included re-intervention rate, number of re-interventions, immediate complication, remote complication, and time to clinical resolution after the procedure. Results:A sum of 81 patients were included: 14 underwent EUS-TD, and 67 underwent PD. There were significant differences between groups in POPC size and type of surgery. Propensity-score matching selected 13 patients who underwent EUS-TD and 28 who underwent PD. Re-intervention rate (p = 0.045), and number of re-interventions (p = 0.026) were significantly lower in the matched EUS-TD group than in the matched PD group. There were no significant between-group differences in immediate complication and remote complication. The time to clinical resolution after the procedure was significantly shorter in the matched EUS-TD than in the matched PD group (14 versus 26 days; p < 0.0001). Conclusion:EUS-TD is more effective than PD for drainage of noncapsulated POPC. EUS-TD should be considered as the first treatment of choice for noncapsulated POPC visible on EUS.
journal_name
Therap Adv Gastroenteroljournal_title
Therapeutic advances in gastroenterologyauthors
Tamura T,Kitano M,Kawai M,Tanioka K,Itonaga M,Kawaji Y,Nuta J,Hatamaru K,Yamashita Y,Kitahata Y,Miyazawa M,Hirono S,Okada KI,Yamaue Hdoi
10.1177/1756284819884418subject
Has Abstractpub_date
2019-10-24 00:00:00pages
1756284819884418eissn
1756-283Xissn
1756-2848pii
10.1177_1756284819884418journal_volume
12pub_type
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