Drainage of postoperative pancreatic collections after pancreatic surgery by endoscopic ultrasound-guided approach

Aims: Intraabdominal collections can cause significant morbidity after pancreatic resection, and are usually managed with external radiologically-guided drainage. Endoscopic ultrasound (EUS)-guided drainage has recently become an accepted therapy for internal drainage of pancreatic pseudocysts. This procedure may avoid the long-term management and morbidity related to an external drain. We aim to present our local experience with EUS guided drainage of postoperative fluid collections following pancreatic surgery. Methods: Between May 2013 and December 2014, 4 patients presenting with postoperative collections close to the stomach underwent EUS-guided drainage in a tertiary referral HPB unit in a University Hospital setting. We defined success of the procedure as clinical improvement of symptoms and resolution of the collection on a follow-up CT scan performed 6–8 weeks after the procedure. Results: 4 patients (3 females) underwent EUS-guided drainage for fluid collection following pancreatic surgery (2 distal pancreatectomies, 1 pancreaticoduodenectomy, 1 total pancreatectomy). Two patients had a previous attempt of radiological percutaneous drainage. The median time from surgery to EUS-guided drainage was 70.5 days (range 27–145). Two patients were discharged and re-admitted before the EUS-guided drainage. Resolution of clinical symptoms was achieved in all patients. The follow-up CT scan showed complete resolution of the fluid collections. One patient developed leakage of oral contrast from the stomach into the mediastinum, which was confirmed on CT scan and was successfully treated conservatively. Conclusions: Endoscopic drainage of postoperative pancreatic collections is safe and effective procedure for collections around the stomach. In our experience it represents a valid alternative to the radiologically-guided drainage, is not associated with major complications, precludes the long-term follow-up and morbidity related to external drain, and facilitates early discharge. To the best of our knowledge this is the first case series reported in UK about EUS-guided drainage in management of postoperative intrabdominal collections after pancreatic resection.