Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Can J Gastroenterol Hepatol. 2021 Jan 25;2021:6691705. doi: 10.1155/2021/6691705. eCollection 2021.
Endoscopic ultrasound-guided transluminal drainage (EUS-TD) is generally performed 4 weeks after disease onset for evacuating pancreatic fluid collections. However, the optimal timing for conducting the procedure in those diagnosed with postoperative pancreatic fistula (POPF) has not been established. We aimed to elucidate the efficacy and safety of early EUS-TD procedures for treating POPF.
We retrospectively reviewed patients diagnosed with POPF who underwent EUS-TD in the Kyushu University Hospital between 2008 and 2019. Clinical features were comparatively analyzed between the two patient groups who underwent either early (≤15 days postoperatively) or late (>15 days postoperatively) EUS-TD. Factors prolonging hospital stay were also analyzed using Cox proportional hazard models.
Thirty patients (median age, 64.5 years) were enrolled. The most common initial operation was distal pancreatectomy with splenectomy (60.0%). Median size of POPF was 69.5 (range, 38-145) mm, and median time interval between surgery and EUS-TD was 17.5 (range, 3-232) days. Totally, 47% patients underwent early EUS-TD. Rates of technical success, clinical success, and complications were 100%, 97%, and 6.9%, respectively. No recurrence of POPF occurred during a median follow-up period of 14 months. Clinical characteristics and outcomes were comparable between the early and late drainage patient groups, except for the rates of infection and nonencapsulation of POPF, which were significantly higher in the early drainage group. Performing simultaneous internal and external drainage (hazard ratio (HR): 0.31; 95% confidence interval (CI): 0.11-0.93, =0.04) and conducting ≥2 treatment sessions (HR: 0.26; 95% CI: 0.08-0.84, =0.02) were significantly associated with prolonged hospitalization after EUS-TD.
EUS-TD is a safe and effective method for managing POPF, regardless of when it is performed in the postoperative period. Once infected POPF occurs, clinicians should not hesitate to perform EUS-TD even within 15 days of the initial operation.
内镜超声引导下经腔引流术（EUS-TD）通常在疾病发病后 4 周进行，以排出胰腺积液。然而，对于诊断为术后胰瘘（POPF）的患者，进行该手术的最佳时机尚未确定。我们旨在阐明早期 EUS-TD 治疗 POPF 的疗效和安全性。
我们回顾性分析了 2008 年至 2019 年期间在九州大学医院接受 EUS-TD 治疗的 POPF 患者。比较了两组患者的临床特征，这两组患者分别进行了早期（术后≤15 天）或晚期（术后>15 天）EUS-TD。还使用 Cox 比例风险模型分析了延长住院时间的因素。
共纳入 30 例患者（中位年龄 64.5 岁）。最常见的初始手术是胰体尾切除术加脾切除术（60.0%）。POPF 的中位大小为 69.5（范围 38-145）mm，手术与 EUS-TD 之间的中位时间间隔为 17.5（范围 3-232）天。总共 47%的患者接受了早期 EUS-TD。技术成功率、临床成功率和并发症发生率分别为 100%、97%和 6.9%。中位随访 14 个月期间，未发生 POPF 复发。早期和晚期引流患者组的临床特征和结局相当，除了感染率和 POPF 非包裹率，早期引流组明显更高。同时进行内引流和外引流（风险比（HR）：0.31；95%置信区间（CI）：0.11-0.93，=0.04）和进行≥2 次治疗（HR：0.26；95%CI：0.08-0.84，=0.02）与 EUS-TD 后住院时间延长显著相关。
EUS-TD 是一种安全有效的治疗 POPF 的方法，与术后何时进行无关。一旦发生感染性 POPF，即使在初始手术后 15 天内，临床医生也不应犹豫进行 EUS-TD。
