Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointest Endosc. 2020 May;91(5):1085-1091.e1. doi: 10.1016/j.gie.2019.11.045. Epub 2019 Dec 13.
EUS-guided postoperative drainage (EUS-POD) of postoperative fluid collections (POFCs) is typically delayed until a thick wall has formed to optimize safety. Thus, percutaneous drainage is the mainstay of early POFC management. The primary aim of this study was to compare technical and clinical success and adverse event (AE) rate between early (0-30 days postoperative) compared with delayed (>30 days) EUS-POD. The secondary aim was to determine predictors for clinical success and AE rate associated with early compared with delayed EUS-POD.
This was a retrospective analysis of consecutive patients undergoing EUS-POD between November 2013 and November 2018 at a single tertiary academic center. Demographic, procedural, and outcomes data were recorded. Clinical success was defined as resolution of symptoms and the fluid collection on cross-sectional imaging without recurrence after transluminal stent removal.
Seventy-five patients underwent EUS-POD; 42 (56%) were early, of whom 20 were acute. Sixty-three patients (84%) had undergone distal pancreatectomy. Technical success was 100%, and clinical success was achieved in 70 patients (93%) after a mean 2.2 procedures (range, 1-5). Prior percutaneous drainage had been performed in 13 patients (17.3%). Both acute and early drainage versus delayed EUS-POD demonstrated similar rates of clinical success (95% and 93% vs 94%, P = .99) and AEs (21.4% and 15% vs 30.3%, P = .43). Necrosectomy was required less often in the early versus the delayed group. No predictors of clinical success were identified. Early EUS-POD was not a predictor of AEs (P = .65). Infection and collection size >10 cm correlated with increased AE risk (P = .048 and .007, respectively).
Early and even acute EUS-POD of POFCs appears to be technically feasible, clinically effective, and safe. EUS-POD should be considered for definitive management of early symptomatic POFCs.
EUS 引导下的术后积液（EUS-POD）引流通常延迟到形成厚壁以优化安全性后进行。因此，经皮引流是早期 POFC 管理的主要方法。本研究的主要目的是比较早期（术后 0-30 天）与延迟（>30 天）EUS-POD 的技术和临床成功率以及不良事件（AE）发生率。次要目的是确定与早期相比，与延迟 EUS-POD 相关的临床成功率和 AE 发生率的预测因素。
这是一项回顾性分析，纳入 2013 年 11 月至 2018 年 11 月在一家三级学术中心接受 EUS-POD 的连续患者。记录人口统计学、程序和结果数据。临床成功定义为症状缓解，横断面成像上的积液消失，经皮支架取出后无复发。
75 例患者接受了 EUS-POD；42 例（56%）为早期，其中 20 例为急性。63 例（84%）接受了胰体尾切除术。技术成功率为 100%，70 例（93%）患者在平均 2.2 次（范围 1-5 次）操作后达到临床成功。13 例（17.3%）患者此前接受过经皮引流。急性和早期引流与延迟 EUS-POD 的临床成功率相似（95%和 93%与 94%，P=0.99），AE 发生率相似（21.4%和 15%与 30.3%，P=0.43）。早期组比延迟组更不需要进行坏死组织清除术。未发现临床成功的预测因素。早期 EUS-POD 不是 AE 的预测因素（P=0.65）。感染和积液大小>10 cm 与 AE 风险增加相关（P=0.048 和 0.007）。
早期甚至急性 POFC 的 EUS-POD 似乎在技术上是可行的，临床有效且安全。EUS-POD 应考虑用于早期有症状 POFC 的确定性治疗。
