First intention EUS-guided transluminal drainage with LAMS: an effective and safe method for management of fluid collections after any kind of surgery

Aims Symptomatic postoperative collections (PCs) frequently complicate abdominal surgery with significant morbidity and mortality. By analogy with post pancreatitis inflammatory collections, endoscopic ultrasound (EUS)-guided drainage using a lumen apposing metal stent (LAMS) has emerged as an alternative to the traditional percutaneous treatment. However, little is known about drainage with LAMS of PCs as first intention. The aim of this study is to report our experience and evaluate the safety and efficacy of EUS-PCD (EUS post-operative collection drainage) as a first-line drainage approach for all types of PCs.

Methods This is a monocentric retrospective study. We retrieved all consecutive patients with symptomatic PCs who underwent EUS-PCD between February 2019 and September 2024. Multiple (nonrecurrent) PCs in the same patient were considered separately. All cases were considered suitable for first intention treatment by EUS-PCD after multidisciplinary discussion. All procedures were performed with the AXIOSâ system. Rates of technical success, clinical success, and AEs are calculated on the number of collections.

Results We enrolled 64 patients and 66 PCs, mainly resulting from pancreatic and lower gastrointestinal-tract surgery. The median size of collections was 7.6 cm, 56 were mixed (solid-liquid), and infection occurred in 54 of the cases. The median time from surgery to drainage was 19 days (IQR 13-29), and in 10 cases this occurred≤7days after surgery. 51 drainages were performed from the gastric or duodenal window, 15 transrectally. LAMS were removed after a median time of 18.5 days (IQR 12-27). After removal, double-pigtails stents placement was performed in 25 PCs and at least one necrosectomy session was performed in 13 of them. Technical success was achieved in 97.0% of cases. Clinical success was achieved in 95.2%; in the 3 cases of failure for collection recurrence, retreatment with LAMS was successful. The overall AEs rate was 9.1%, but we recorded only one severe case that required surgery (chronic fistula between a perirectal residual pseudocavity and the upstream colon after transrectal drainage). Rates of clinical failure and AEs was not affected by surgery type (pancreatic, non-pancreatic), timing of drainage (≤ 7, 7-10, > 10days), size of collections (≤ 4, 4-10,>10cm), access window (transgastric/duodenal/rectal) [1] [2] [3].

Conclusions First intention EUS-PCD seems to be a very effective treatment, regardless of the origin and size of the collection and the time of drainage. The safety profile was also found to be satisfactory, and most importantly, in our experience we have not recorded any case of perforation or hemorrhage and death.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Donatelli G. et al. “Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery,” Surg. Endosc. 2018; 32 no. 5.
• 2 Capurso G. et al. “The i-EUS consensus on the management of pancreatic fluid collections – Part 1,”. Dig Liver Dis 2024; 56 no. 10 pp. 1663-1674
• 3 Trieu JA, Baron TH. “The use of endoscopic ultrasound in the management of post-surgical and pancreatic fluid collections,” Best Practice and Research: Clinical Gastroenterology. 2022; vol. 60–61.