Endoscopic ultrasound-guided transmural drainage for pancreatic fistula or pancreatic duct dilatation after pancreatic surgery

Background Endoscopic ultrasound (EUS)-guided drainage is widely used to manage pancreatic pseudocysts. Several studies have reported the use of EUS-guided drainage for pancreatic fistula and stasis of pancreatic juice caused by stricture of the pancreatic duct after pancreatic resection. Methods In total, 262 patients underwent surgery involving pancreatic resection in our hospital from April 2005 to March 2010. Ninety patients (34%) developed a grade B or C postoperative pancreatic fistula (POPF) that required additional treatment. We performed EUS-guided transmural drainage (EUS-TD) for six patients (2.1%) with a pancreatic fistula or dilatation of the main pancreatic duct visible by EUS. Eighteen patients (6.8%) received percutaneous drainage. The success rates of EUS-TD and percutaneous drainage were compared in a retrospective analysis. Results EUS-TD was successfully performed without complications in all six cases, with five of the six patients being successfully treated with only one trial of EUS-TD. The final technical success rate was 100% for EUS-TD and for percutaneous drainage. Both the short-term and long-term clinical success rates of EUS-TD were 100%, and those of percutaneous drainage were 61.1% and 83%, respectively. The differences in these rates were not significant (short-term success, P = 0.091; long-term success, P = 0.403). However, the period to clinical success was significantly shorter with EUS-TD (5.8 days) than with percutaneous drainage (30.4 days; P = 0.0013) in our series. Conclusions EUS-TD appears to be a safe and technically feasible alternative to percutaneous drainage and may be considered a first-line therapy for pancreatic fistulas visible by EUS.