S1084 Endoscopic Ultrasound-Guided vs Percutaneous Drainage for the Management of Post-Operative Pancreatic Fluid Collections After Distal Pancreatectomy

Abstract

Introduction: Post-operative pancreatic fluid collections (POPFCs) remain a significant source of morbidity after distal pancreatectomy. Drainage can be performed using percutaneous or endoscopic approaches, but comparative data are limited. This study compared endoscopic ultrasound-guided drainage (EUSD) with percutaneous drainage (PTD) in the management of symptomatic POPFCs after distal pancreatectomy. The primary aim is to compare rates of clinical success, defined as symptomatic improvement and radiographic resolution without requiring an alternate drainage modality. Secondary outcomes included technical success, total number of interventions, time to resolution, rates of adverse events (AEs), and POPFC recurrence. Methods: Adults who underwent distal pancreatectomy from January 2012 to August 2021 and developed symptomatic POPFC were identified retrospectively from a single academic center electronic medical record and a prospectively maintained pancreatic surgery database. Demographic data, procedural data, and clinical outcomes were abstracted. Quantitative variables were described with median and interquartile ranges and compared using a two-tailed t-test. In addition, categorical data were reported as frequencies and compared using Chi-squared or Fisher exact tests. Results: Of 1046 patients that underwent distal pancreatectomy, 217 met study inclusion criteria (median age 60 years, 51.2% female) of whom 106 underwent EUSD and 111 PTD. There were no significant differences in baseline characteristics including age, gender, pathology, and POPFC size (Table). PTD was generally performed earlier after surgery (10 vs. 27 days; p = < 0.001) and more commonly in the inpatient setting (82.9% vs. 49.1%; p≤0.001). EUSD was associated with a significantly higher rate of clinical success (92.5% vs. 76.6%; p=0.001), fewer median number of interventions (2 vs. 4; p≤0.001), and lower rate of POPFC recurrence (7.6% vs. 20.7%; p=0.007). Drain dwell time was shorter for patients who underwent PTD (37 vs. 46 days; p=0.013). AEs were more frequent after EUSD but did not reach a level of statistical significance (10.4% vs 6.3%, p=0.28); with approximately 1/3 of EUSD AEs due to stent migration. Conclusion: In patients with POPFCs after distal pancreatectomy, EUSD was associated with higher rates of clinical success, fewer interventions, and lower rates of recurrence. EUSD should be considered for management of POPFCs in centers with technical expertise. Table 1. - Baseline characteristics and clinical outcomes of patients who developed post-operative pancreatic fluid collections after distal pancreatectomy Baseline Characteristics EUSDN =106 PTDN = 111 P value Age, years, median (IQR) 60 (48-68) 60 (55-68.5) 0.09 Female, no. (%) 52(49.1) 59 (53.1) 0.54 Laparoscopic surgery, no. (%) 56 (52.8) 34(30.6) 0.002 Pancreatic pathology, no. (%) Ductal adenocarcinoma 43 (31.1) 40 (29.7) Neuroendocrine tumor 32 (30.2) 33 (29.7) Intraductal papillary mucinous neoplasm 12 (11.3) 8 (7.2) Other* 19 (17.9) 30 (27.0) Inpatient, no. (%) 52 (49.1) 92(82.9) < 0.001 Presence of solid necrosis, no. (%) 48 (45.3) 11 (9.9) < 0.001 Infected POPFC, no. (%) 42 (39.6) 30 (27.0) 0.06 Maximum diameter in cm, Median (IQR) 7.4 (5.2-10.0) 6.7 (5.1-10.0) 0.45 Time to drainage from surgery, days, median (IQR) 27.0 (13.5-46.5) 10.0 (7.00-18.3) < 0.001 Clinical Outcomes Clinical success, no. (%) 98 (92.5) 85 (76.6) 0.001 Technical success, no. (%) 106(100) 111(100) Procedure related adverse events, no. (%) 11(10.4) 7 (6.3) 0.28 Number of interventions, median (IQR) 2 (2-4) 4 (2-6) < 0.001 Time to drain removal, days, median, (IQR) 45.5 (31.5-73.0) 37.0 (24.0-61.0) 0.013 Recurrence, no. (%) 8 (7.6) 23 (20.7) 0.007 Footnotes: EUSD: EUS-guided drainage; PTD: Percutaneous drainage; POPFC: Post-operative pancreatic fluid collection*Other pathologies: serous cystadenoma (EUSD n=2; PTD n=3), sarcoma (EUSD n=3; PTD n=6), chronic pancreatitis (EUSD n=3; PTD n=5), insulinoma (EUSD n=1; PTD n=5), other metastatic disease (EUSD n=10; PTD n=11).