Endoscopic ultrasound-guided transmural drainage for pancreatic fistula or pancreatic duct dilation after pancreatic surgery
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Background: Endoscopic ultrasound (EUS)-guided drainage is widely used to manage pancreatic pseudocysts. Several studies have reported the use of EUS-guided drainage for pancreatic fistula and stasis of pancreatic juice caused by stricture of the pancreatic duct after pancreatic resection. Methods: In total, 262 patients underwent surgery involving pancreatic resection in our hospital from April 2005 to March 2010. Ninety patients (34%) developed a grade B or C postoperative pancreatic fistula (POPF) that required additional treatment. We performed EUS-guided transmural drainage (EUS-TD) for six patients (2.1%) with a pancreatic fistula or dilation of the main pancreatic duct visible by EUS. Eighteen patients (6.8%) received percutaneous drainage. The success rates for EUS-TD and percutaneous drainage were compared in a retrospective analysis. Results: EUS-RD was successfully performed without complications in all six cases, with five of the six patients being successfully treated with only one trial of EUS-TD. The final technical success rate was 100% for EUS-TD and for percutaneous drainage. Both the short-term and long-term clinical success rates for EUS-TD were 100%, and those of percutaneous drainage were 61.1% and 83%, respectively. The differences in these rates were not significant (short-term success, P = 0.091; long-term success, P = 0.403). However, the period to clinical success was significantly shorter with EUS-TD (5.8 days) than with percutaneous drainage (30.4 days; P = 0.0013) in our series. Conclusions: EUS-TD appears to be a safe and technically feasible alternative to percutaneous drainage and may be considered a first-line therapy for pancreatic fistulas visible by EUS.
- Springer New Yorkの論文
- 2012-06-00
Springer New York | 論文
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