S3081 The Common Clinical Manifestations and Interventions for Post-Pancreaticoduodenectomy-Related Adverse Events

Abstract

INTRODUCTION: Despite improvements in surgical technique in pancreaticoduodenectomy (PD), postoperative morbidity is still present 30-40% of the time. Thus, as the indications for pancreatic resection have broadened, endoscopic retrograde cholangiopancreatography (ERCP) has become essential in the management of post-PD-related adverse events (AE). In this study, we characterized the common clinical manifestations and interventions performed for post-PD-related AEs. METHODS: We retrospectively evaluated patients with prior classic or pylorus-preserving PD who received ERCP from 01/13/06 - 01/16/19. The pertinent demographic information, oncologic history, and follow-up information were extracted. Outcomes included technical success rate - the ability to treat stricture with dilation or stent placement, and clinical success rate - a documented decrease in bilirubin to normal or 50% of peak value within 2 weeks. Statistical analysis was done using Stata/SE version 16.0. RESULTS: A total of 28 patients (75% male; median age 66 years, range 22-86 years) with prior PD received 66 ERCPs for choledochojejunostomy (25 patients received 63 ERCPs) and pancreaticojejunostomy (3 patients received 3 ERCPs) evaluation. All 3 ERCPs for pancreatic assessment were unsuccessful. PD was most commonly performed for pancreatic adenocarcinoma (n = 15) and pancreatic neuroendocrine tumor (n = 5) [Table 1]. A total of 11 patients received neoadjuvant therapy: 8 had chemoradiation, 3 had chemotherapy only. Most cases were performed with an advanced fellow and had a median duration of 56.5 min (range 12.0-161.0). The most common indications for initial ERCP were cholangitis (n = 15) and biliary obstruction without cholangitis (n = 7). An additional 38 ERCPs were necessary in 9 patients (median 4 ERCPs/patient; range 2-13/patient) most commonly for cholangitis (n = 17) and biliary stricture (n = 10) [Table 2]. All strictures were treated with balloon dilation and a total of 38 stents were placed. The technical success rate was 81.0% (51/63 ERCPs) and the clinical success rate was 76.2% (48/63 ERCPs). Procedure-related-AEs occurred in 5/66 ERCPs (7.6%): 4 cases of self-resolving fever, 1 case of mild cholangitis. CONCLUSION: Patients with prior PD commonly require routine ERCP for the management of postoperative AEs. ERCP is an effective and safe treatment modality for post-PD-related hepatobiliary sequela, but improvements are necessary for pancreatic intervention.Table 1Table 2