Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany.
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany.
Gastrointest Endosc. 2019 Feb;89(2):311-319.e1. doi: 10.1016/j.gie.2018.08.046. Epub 2018 Sep 1.
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.
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.
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). 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). 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).
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.
胰腺部分切除术后胰漏和瘘（POPF）是主要的不良事件。目前尚无标准化的治疗方案，内镜治疗的证据也很少。
回顾性分析来自柏林、基尔和德累斯顿中心的 196 例伴有（n=132）和不伴有（n=64）胰液积聚（PFC）的 POPF 患者。以临床缓解为主要分析终点。
分析分为有或无 PFC 两组，因为这些患者在治疗途径和全身炎症方面存在差异，无 PFC 患者的 C 反应蛋白中位数为 30.7mg/dL，而有 PFC 患者为 131.0mg/dL（P=3.4×10）。对于有 PFC 的患者，EUS 引导的介入治疗中位缓解时间为 8 天，而经皮引流为 25 天，手术为 248 天（P=3.75×10）。EUS 作为主要治疗方式的成功率较高，为 85%（P=0.034），其次是经皮引流（64%）和手术（41%），有趋势表明这一结果。作为挽救性治疗（n=24），EUS 引导治疗后 96%的患者临床缓解。对于无 PFC 的患者，新型内镜技术下 EUS 引导内引流中位缓解时间为 4 天，而剩余的外科引流为 51 天（P=9.3×10）。
在这项回顾性分析中，EUS 引导引流 POPF 可更快缓解。EUS 可作为 PFC 和 POPF 治疗的一种可行选择，应在前瞻性研究中进一步评估。
