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Effectiveness of early endoscopic ultrasound-guided drainage for postoperative fluid collection

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Abstract

Background

Postoperative abdominal fluid collections (PAFCs) are a potentially fatal complication of pancreatobiliary surgery. Endoscopic ultrasound (EUS)-guided drainage has recently been shown to be effective in treating PAFCs of more than 4 weeks old. Little is currently known, however, regarding the EUS-guided drainage of PAFCs of less than 4 weeks. This study assessed the efficacy and safety of the early drainage (< 4 weeks) of PAFCs via EUS guidance.

Methods

The data of patients who had undergone EUS-guided PAFC drainage between July 2008 and January 2018 were retrospectively analyzed. Data of EUS-guided PAFC drainage were obtained from prospectively collected EUS database of our institute and reviewed of patients’ clinical parameters based on electrical medical record.

Results

A total of 48 patients who had undergone EUS-guided PAFC drainage within 4 weeks of pancreatobiliary surgery were enrolled. The indications of procedure included abdominal pain (n = 27), fever (n = 18), leukocytosis (n = 2), and increased size of PAFC during external tube drainage (n = 1). Technical success was achieved in all cases, and the clinical success rate was 95.8% (46/48). Four patients underwent secondary procedures. The median period from surgery to EUS-guide drainage was 14 days (Interquartile range [IQR] 10–16), and median time to resolution was 23.5 days (IQR 8.5–33.8). Adverse events occurred in two cases that were developed intracystic bleeding and were successfully resolved by arterial coil embolization.

Conclusions

Early EUS-guided drainage is a technically feasible, effective, and safe method in patients who have developing PAFCs within 4 weeks of pancreatobiliary surgery.

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Abbreviations

PAFC:

Postoperative abdominal fluid collection

EUS:

Endoscopic ultrasound

NCD:

Nasocystic drainage

IQR:

Interquartile range

CT:

Computed tomography

FCSEMS:

Fully covered self-expanding metal stent

DP stent:

Double-pigtail plastic stent

LAMS:

Lumen-apposing metal stent

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Author notes

  1. Hwaryong Lee and Dongwook Oh contributed equally to this article as first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Korea

    Dongwook Oh, Tae Jun Song, Do Hyun Park, Sung Koo Lee, Myung-Hwan Kim & Sang Soo Lee

  2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Hwaryong Lee & Sang Soo Lee

  3. Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea

    Ki Byung Song, Jae Hoon Lee, Dae Wook Hwang & Song Cheol Kim

  4. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Seung Soo Lee

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Contributions

Study concept and design: SSL; acquisition of data analysis and interpretation of data: HRL, DWO, TJS, DHP, SKL, MHK, KBS, JHL, DWH, SCK, and SSL; drafting of the manuscript: HRL and DWO; critical revision of the manuscript for important intellectual content: HRL, DWO, and SSL; statistical analysis: HRL and DWO; supervision: SSL.

Corresponding author

Correspondence to Sang Soo Lee.

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Disclosures

Drs. Dongwook Oh, Hwaryong Lee, Tae Jun Song, Do Hyun Park, MD, Sung Koo Lee, Myung-Hwan Kim, Ki Byung, Song, Jae Hoon Lee, Dae Wook Hwang, Song Cheol Kim, Seung Soo Lee, and Sang Soo Lee have no conflicts of interest or financial ties to disclose.

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Guarantor of the article: Sang Soo Lee, MD, PhD, FASGE

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Oh, D., Lee, H., Song, T.J. et al. Effectiveness of early endoscopic ultrasound-guided drainage for postoperative fluid collection. Surg Endosc 36, 135–142 (2022). https://doi.org/10.1007/s00464-020-08247-3

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