Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
Department of Digestive Surgery, Institut Mutualiste Montsouris, 75014, Paris, France.
Surg Endosc. 2018 May;32(5):2281-2287. doi: 10.1007/s00464-017-5922-1. Epub 2017 Nov 2.
Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections.
Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed.
Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31-74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n = 5), and other type of surgery (n = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6-360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy.
The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.
术后积液是腹部手术后发生并发症的一个公认原因。目前，经皮引流被认为是标准治疗方法，但并非所有积液都可以通过这种方法引流。自从采用超声内镜（EUS）以来，内镜经壁引流在处理此类并发症方面已成为一种有吸引力的选择。本研究旨在评估内镜经壁引流治疗术后积液的疗效、安全性和方法。
回顾性分析 2014 年至 2017 年间因经皮引流失败或认为不可能时，因症状性术后积液而转至我们专门的多学科治疗中心进行内镜引流的所有患者的数据。
共纳入 32 例患者（17 名男性和 15 名女性），中位年龄为 53 岁（范围 31-74 岁）。积液来源于胰腺（n=10）、结直肠（n=6）、减重（n=5）和其他类型的手术（n=11）。10 例（31%）患者的积液直径小于 5cm，17 例（53%）患者的积液直径在 5-10cm 之间，5 例（16%）患者的积液直径大于 10cm。从手术到内镜引流的中位时间为 38 天（范围 6-360 天）。8 例（25%）患者行内镜引导下引流，24 例（75%）患者行超声内镜引导下引流。技术成功率为 100%，平均随访 13.5 个月（1.2-24.8 个月）后，30 例（93.4%）患者获得临床成功。总并发症发生率为 12.5%，包括 4 例经胃引流后出血患者，经保守治疗后治愈。
本系列研究表明，当经皮引流不可行或失败时，内镜经壁引流是治疗术后积液的一种有吸引力的替代方法。
