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Background <p>Symptomatic postoperative&#xa0;fluid collections (POFCs) can result in significant morbidity and mortality after abdominal surgery requiring timely intervention. EUS-guided drainage&#xa0;is traditionally delayed up to four weeks to allow wall maturation and reduce perforation or peritonitis risk. However, some POFCs may be suitable for earlier intervention. This study compared the efficacy and safety of acute (≤ 15&#xa0;days), early (16–30&#xa0;days), and delayed (&gt; 30&#xa0;days) EUS-guided drainage.</p> Methods <p>A retrospective cohort of patients undergoing EUS-guided drainage for symptomatic POFCs between 2013 and 2023 at a single tertiary center was evaluated. Technical success was defined as accessing and draining a POFC by transmural stent placement on initial endoscopy. Clinical success was defined as radiographically or endosonographically confirmed symptomatic POFC improvement without further percutaneous or surgical intervention.</p> Results <p>Among 85 patients with POFCs, most (61%) had undergone distal pancreatectomy with splenectomy. 59% required drainage ≤ 30&#xa0;days after surgery, with 28% managed acutely. Most (83%) received lumen-apposing metal stents. Overall technical and clinical success rates were 94% and 79%, respectively, after a median 2 endoscopies (IQR 2–3). Success did not differ by timing (technical: 92% vs. 96% vs. 94%; clinical: 83% vs. 85% vs. 71%; <i>P</i> = 0.86 and <i>P</i> = 0.37). Adverse event rates were similar across groups (<i>P</i> = 0.85). Transgastric access was associated with clinical success (<i>P</i> &lt; 0.001) and fewer adverse events (<i>P</i> = 0.03). Transduodenal access predicted technical (<i>P</i> = .05) and clinical failure (<i>P</i> = 0.02).</p> Conclusions <p>In this large single-center experience of symptomatic POFCS, acute and early EUS-guided drainage with lumen-apposing metal stents in carefully selected patients was found to be technically safe and clinically effective, potentially avoiding more morbid interventions such as ERCP, percutaneous drainage, or surgery. Further randomized, prospective studies are needed to define predictors of technical and clinical success as well as adverse events.</p> Graphical Abstract <p></p>

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EUS-guided drainage of symptomatic postoperative fluid collections: a retrospective cohort study evaluating timing of intervention and clinical outcomes

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Muhammad H. Raza,
  • Jonathan R. Tiao,
  • Catherine K. Wang,
  • Lyndon Luk,
  • John B. Doyle,
  • Kazuki N. Sugahara,
  • Beth A. Schrope,
  • Michael D. Kluger,
  • John A. Chabot,
  • Gulam Manji,
  • Tamas A. Gonda,
  • Sara Welinsky,
  • John M. Poneros,
  • Amrita Sethi,
  • Kavel H. Visrodia

摘要

Background

Symptomatic postoperative fluid collections (POFCs) can result in significant morbidity and mortality after abdominal surgery requiring timely intervention. EUS-guided drainage is traditionally delayed up to four weeks to allow wall maturation and reduce perforation or peritonitis risk. However, some POFCs may be suitable for earlier intervention. This study compared the efficacy and safety of acute (≤ 15 days), early (16–30 days), and delayed (> 30 days) EUS-guided drainage.

Methods

A retrospective cohort of patients undergoing EUS-guided drainage for symptomatic POFCs between 2013 and 2023 at a single tertiary center was evaluated. Technical success was defined as accessing and draining a POFC by transmural stent placement on initial endoscopy. Clinical success was defined as radiographically or endosonographically confirmed symptomatic POFC improvement without further percutaneous or surgical intervention.

Results

Among 85 patients with POFCs, most (61%) had undergone distal pancreatectomy with splenectomy. 59% required drainage ≤ 30 days after surgery, with 28% managed acutely. Most (83%) received lumen-apposing metal stents. Overall technical and clinical success rates were 94% and 79%, respectively, after a median 2 endoscopies (IQR 2–3). Success did not differ by timing (technical: 92% vs. 96% vs. 94%; clinical: 83% vs. 85% vs. 71%; P = 0.86 and P = 0.37). Adverse event rates were similar across groups (P = 0.85). Transgastric access was associated with clinical success (P < 0.001) and fewer adverse events (P = 0.03). Transduodenal access predicted technical (P = .05) and clinical failure (P = 0.02).

Conclusions

In this large single-center experience of symptomatic POFCS, acute and early EUS-guided drainage with lumen-apposing metal stents in carefully selected patients was found to be technically safe and clinically effective, potentially avoiding more morbid interventions such as ERCP, percutaneous drainage, or surgery. Further randomized, prospective studies are needed to define predictors of technical and clinical success as well as adverse events.

Graphical Abstract