Endoscopy 2020; 52(01): 78
DOI: 10.1055/a-1021-8703
Letter to the editor
© Georg Thieme Verlag KG Stuttgart · New York

Postoperative fluid collections: a new indication for interventional endoscopic ultrasound?

Yaqi Zhai
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
,
Ningli Chai
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
,
Enqiang Linghu
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
› Author Affiliations
Further Information

Publication History

Publication Date:
18 December 2019 (online)

We read with interest the study by Yang J et al. [1] and congratulate the authors for their innovative works. This retrospective, international, multicenter study showed lumen-apposing metal stents (LAMS) to be a feasible alternative in the management of postoperative fluid collections (POFCs), with good safety and efficacy. This finding will facilitate expanding indications for interventional EUS. We sincerely appreciate the authors sharing their experience, and offer some points requiring clarification.

The definition of clinical success excludes patients with a need for percutaneous drainage, which may introduce bias. Clinically, EUS-guided LAMS drainage is often used in patients with insufficient percutaneous drainage. The large diameter of LAMS is an advantage, as percutaneous drains are often retained for lavage and drainage. In the study, repeated endoscopic procedures and multiple LAMS were permitted to achieve clinical success, whereas additional percutaneous drainage was considered as treatment failure, which is confusing.

According to the International Study Group of Pancreatic Fistula, 56.5 % (35 /62) of POFCs should be attributed to postoperative pancreatic fistula (POPF, Grade B) [2]. Mudireddy et al. [3] reported a similar study, with all 26 pancreatic POFCs resulting from pancreatic duct leaks. In the present study, however, only 12 of 35 pancreatic POFCs were diagnosed with leaks. To promote communication with surgery, it would be better to provide criteria of pancreatic leak and any differences from the universally accepted POPF system.

LAMSs bridge the space between medicine and surgery, but the average number of cases for each center (62 cases, 19 centers) is small. This situation also occurs in China, partly due to insufficient multidisciplinary collaboration. We believe that given the similarity of POFCs and pancreatic pseudocysts, EUS-guided LAMS therapy will be the first-line treatment for POFCs after pancreatectomy [4]. However, for POFCs of other etiologies, we still have a long way to go.