Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula
Background. 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 bee...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2021/6691705 |
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| author | Nao Fujimori Takashi Osoegawa Akira Aso Soichi Itaba Yosuke Minoda Masatoshi Murakami Kazuhide Matsumoto Katsuhito Teramatsu Yu Takamatsu Takehiro Takaoka Takamasa Oono Eikichi Ihara Tomoharu Yoshizumi Takao Ohtsuka Masafumi Nakamura Yoshihiro Ogawa |
| author_facet | Nao Fujimori Takashi Osoegawa Akira Aso Soichi Itaba Yosuke Minoda Masatoshi Murakami Kazuhide Matsumoto Katsuhito Teramatsu Yu Takamatsu Takehiro Takaoka Takamasa Oono Eikichi Ihara Tomoharu Yoshizumi Takao Ohtsuka Masafumi Nakamura Yoshihiro Ogawa |
| author_sort | Nao Fujimori |
| collection | DOAJ |
| description | Background. 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. Methods. 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. Results. 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, p=0.04) and conducting ≥2 treatment sessions (HR: 0.26; 95% CI: 0.08–0.84, p=0.02) were significantly associated with prolonged hospitalization after EUS-TD. Conclusions. 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. |
| format | Article |
| id | doaj-art-b19afd47f57b4adaa3ed38fdfe135ff3 |
| institution | Kabale University |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-b19afd47f57b4adaa3ed38fdfe135ff32025-02-03T01:00:28ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972021-01-01202110.1155/2021/66917056691705Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic FistulaNao Fujimori0Takashi Osoegawa1Akira Aso2Soichi Itaba3Yosuke Minoda4Masatoshi Murakami5Kazuhide Matsumoto6Katsuhito Teramatsu7Yu Takamatsu8Takehiro Takaoka9Takamasa Oono10Eikichi Ihara11Tomoharu Yoshizumi12Takao Ohtsuka13Masafumi Nakamura14Yoshihiro Ogawa15Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanBackground. 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. Methods. 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. Results. 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, p=0.04) and conducting ≥2 treatment sessions (HR: 0.26; 95% CI: 0.08–0.84, p=0.02) were significantly associated with prolonged hospitalization after EUS-TD. Conclusions. 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.http://dx.doi.org/10.1155/2021/6691705 |
| spellingShingle | Nao Fujimori Takashi Osoegawa Akira Aso Soichi Itaba Yosuke Minoda Masatoshi Murakami Kazuhide Matsumoto Katsuhito Teramatsu Yu Takamatsu Takehiro Takaoka Takamasa Oono Eikichi Ihara Tomoharu Yoshizumi Takao Ohtsuka Masafumi Nakamura Yoshihiro Ogawa Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula Canadian Journal of Gastroenterology and Hepatology |
| title | Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula |
| title_full | Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula |
| title_fullStr | Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula |
| title_full_unstemmed | Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula |
| title_short | Efficacy of Early Endoscopic Ultrasound-Guided Transluminal Drainage for Postoperative Pancreatic Fistula |
| title_sort | efficacy of early endoscopic ultrasound guided transluminal drainage for postoperative pancreatic fistula |
| url | http://dx.doi.org/10.1155/2021/6691705 |
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