EUS-guided drainage resolves most postoperative pancreatic fluid collections

In a retrospective multicenter cohort of 265 patients treated at three academic centers, endoscopic ultrasound-guided drainage achieved clinical success in 73%. Outcomes were less favorable after distal pancreatectomy than after pancreaticoduodenectomy, with more reinterventions and lower adjusted odds of success.

Clinical success occurred in 73% of patients.
Single-procedure success was 60%.
Distal pancreatectomy was linked to more reintervention.
Twenty patients required percutaneous or surgical step-up.

This retrospective cohort study included 265 patients who underwent endoscopic ultrasound (EUS)-guided drainage of postoperative pancreatic fluid collections after pancreatic surgery at three academic centers between 2014 and August 2024. The primary outcome was clinical success, defined as radiological and clinical resolution without percutaneous or surgical step-up intervention. Patients had a mean age of 64 years; 52% underwent drainage within 14 days of surgery, and 51% of collections had a necrotic component.

Clinical success was achieved in 194 patients (73%; 95% CI 67.5–78.1%). This included 160 patients (60%) treated successfully after one procedure and 34 after additional endoscopic reinterventions. Twenty patients (7.6%) required percutaneous or surgical step-up. Compared with pancreaticoduodenectomy, distal pancreatectomy was associated with more reintervention (32% vs 20%; p=0.02) and lower adjusted odds of clinical success (OR 0.53; 95% CI 0.29–0.98; p=0.04).

The findings suggest EUS-guided drainage can achieve resolution in many patients in expert centers, while treatment after distal pancreatectomy may be more complex. The retrospective design and restriction to three academic centers limit generalizability; the abstract does not provide detailed adverse-event rates or comparative outcomes against other initial treatment strategies.

In practice

For patients with postoperative pancreatic fluid collections, this multicenter retrospective cohort suggests EUS-guided drainage can achieve clinical resolution in many cases at experienced centers: success was 73%, with 60% succeeding after one procedure. Distal pancreatectomy was associated with more reintervention and lower odds of success than pancreaticoduodenectomy, which may help set expectations about treatment complexity. These findings do not establish superiority over alternative initial approaches; the study was retrospective and conducted at three academic centers, so results may not generalize to less experienced settings.

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Source

Endoscopy: Predictors of clinical success in endoscopic ultrasound-guided drainage of postoperative pancreatic fluid collections ↗

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