Miyamoto Ryoichi, Takahashi Amane, Ogura Toshiro, Kitamura Kei, Ishida Hiroyuki, Matsudaira Shinichi, Suzuki Yuko, Shimizu Satoshi, Kawashima Yoshiyuki
Department of Gastroenterological Surgery Saitama Cancer Center Saitama Japan.
Department of Gastroenterological Surgery Tokyo Medical University Ibaraki Medical Center Ibaraki Japan.
DEN Open. 2023 Jul 2;4(1):e270. doi: 10.1002/deo2.270. eCollection 2024 Apr.
Postoperative pancreatic fistula (POPF) is a major cause of morbidity after pancreatic surgery. Recently, endoscopic ultrasound-guided transmural drainage (EUS-TD) has been widely used to manage pancreatic pseudocysts after acute pancreatitis. Several studies have reported the effectiveness of EUS-TD for POPF, although there is insufficient evidence regarding the performance of EUS-TD for POPF. We herein report on the safety, efficacy, and appropriate timing of EUS-TD for POPF compared with conventional percutaneous intervention.
Eight patients who underwent EUS-TD of POPF and 36 patients who underwent percutaneous intervention were retrospectively enrolled. Clinical outcomes, including technical success, clinical success, and complications, were analyzed among the two groups.
In terms of clinical outcomes between the EUS-TD and percutaneous intervention groups, significant differences were observed in the number of interventions (1 vs. 4, = 0.011), period of clinical success (6 days vs. 11 days, = 0.001), incidence of complications (0 vs. 3, = 0.021), postoperative hospital stays (27 days vs. 34 days, = 0.027), and recurrence of POPF (0 vs. 5, = 0.001).
EUS-TD for POPF appears to be safe and technically feasible. This approach should be considered a therapeutic option in patients with POPF after pancreatic surgery.
术后胰瘘（POPF）是胰腺手术后发病的主要原因。近来，内镜超声引导下经壁引流术（EUS-TD）已广泛用于治疗急性胰腺炎后的胰腺假性囊肿。多项研究报道了EUS-TD治疗POPF的有效性，尽管关于EUS-TD治疗POPF的性能证据不足。我们在此报告EUS-TD治疗POPF与传统经皮介入治疗相比的安全性、有效性及合适时机。
回顾性纳入8例行EUS-TD治疗POPF的患者和36例行经皮介入治疗的患者。分析两组的临床结局，包括技术成功率、临床成功率及并发症。
在EUS-TD组和经皮介入治疗组的临床结局方面，在干预次数（1次对4次，P = 0.011）、临床成功时间（6天对11天，P = 0.001）、并发症发生率（0对3例，P = 0.021）、术后住院时间（27天对34天，P = 0.027）及POPF复发率（0对5例，P = 0.001）方面观察到显著差异。
EUS-TD治疗POPF似乎是安全且技术上可行的。这种方法应被视为胰腺手术后发生POPF患者的一种治疗选择。
