Background and Aims

Postoperative pancreatic leakage and fistulae (POPF) are a leading adverse event after partial pancreatic resection. Treatment algorithms are currently not standardized. Evidence regarding the role of endoscopy is scarce.

Methods

One hundred ninety-six POPF patients with (n = 132) and without (n = 64) concomitant pancreatic fluid collections (PFCs) from centers in Berlin, Kiel, and Dresden were analyzed retrospectively. Clinical resolution was used as the primary endpoint of analysis.

Results

Analysis was stratified by the presence or absence of a PFC because these patients differed in treatment pathway and the presence of systemic inflammation with a median C-reactive protein of 30.7 mg/dL in patients without a PFC versus 131.0 mg/dL in patients with a PFC (P = 3.4 × 10^–4). In patients with PFCs, EUS-guided intervention led to resolution in a median of 8 days as compared with 25 days for percutaneous drainage and 248 days for surgery (P = 3.75 × 10^–14). There was a trend toward a higher success rate of EUS-guided intervention as a primary treatment modality with 85% (P = .034), followed by percutaneous drainage (64%) and surgery (41%). When applied as a rescue intervention (n = 24), EUS led to clinical resolution in 96% of cases. In patients without PFCs, EUS-guided internalization in a novel endoscopic technique led to resolution after a median of 4 days as compared with 51 days for a remaining surgical drainage (P = 9.3 × 10^–9).

Conclusions

In this retrospective analysis, EUS-guided drainage of POPF led to a more rapid resolution. EUS may be considered as a viable option in the management of PFCs and POPF and should be evaluated in prospective studies.

中文翻译：

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EUS引导的引流在术后胰漏和瘘管的治疗中（带视频）

背景和目标

胰腺局部切除后，术后胰漏和瘘管（POPF）是最主要的不良事件。治疗算法目前尚未标准化。关于内窥镜检查作用的证据很少。

方法

回顾性分析了来自柏林，基尔和德累斯顿中心的196例有（n = 132）和无（n = 64）伴随胰液收集（PFC）的POPF患者。临床分辨率用作分析的主要终点。

结果

有无PFC对患者进行了分层分析，因为这些患者的治疗途径不同，并且全身性炎症的存在，无PFC的患者的C反应蛋白中位数为30.7 mg / dL，而有PFC的患者的中位C反应蛋白为131.0 mg / dL。 PFC（P  = 3.4×10 ^–4）。在PFC患者中，EUS指导的干预导致中位消退的时间为8天，而经皮引流为25天，而手术为248天（P  = 3.75×10 ^–14）。EUS指导的干预作为主要治疗方式的成功率呈上升趋势，为85％（P = .034），然后进行经皮引流（64％）和手术（41％）。当用作急救干预措施（n = 24）时，EUS在96％的病例中导致了临床缓解。对于没有PFC的患者，采用EUS引导的新型内镜技术内化术在中位4天后可解决，而剩余的手术引流则需要51天（P  = 9.3×10 ^–9）。

结论

在这项回顾性分析中，EUS引导的POPF引流导致了更快速的解决。EUS在PFC和POPF的管理中可能被认为是可行的选择，应在前瞻性研究中对其进行评估。