Clinical Outcomes and Risk Factors for Adverse Events Associated With Endoscopic Ultrasound-Guided Drainage of Postoperative Pancreatic Fluid Collections Following Distal Pancreatectomy

초록

Background and Aim Endoscopic ultrasound (EUS)-guided drainage is widely used for postoperative pancreatic fluid collections (PO-PFCs). However, concerns regarding adverse events persist. We aimed to assess clinical outcomes and identify risk factors for adverse events following endoscopic ultrasound-guided drainage of postoperative pancreatic fluid collections after distal pancreatectomy.Methods We retrospectively analyzed 124 patients who underwent EUS-guided drainage for PO-PFCs following distal pancreatectomy. The clinical and procedural data were also evaluated. Risk factors for adverse events and post-procedural bleeding were identified using univariate and multivariate logistic regression analyses. Subgroup analyses were performed before and after the introduction of the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS).Results Technical and clinical success rates were 100% and 92.7%, respectively. Adverse events occurred in 25.8% (32/124) of patients. Moderate-to-severe bleeding occurred in 11 patients, of whom 10 required embolization or emergency surgery. Paracolic gutter extension was an independent risk factor for adverse events. Factors associated with post-procedural bleeding included paracolic extension, longer procedure time, antiplatelet or anticoagulant use, and the combined use of electrocautery and mechanical dilators. In the subgroup analysis before and after EC-LAMS introduction, adverse events were less frequent (31.9% vs. 18.2%), but the difference was not statistically significant (p = 0.10).Conclusions EUS-guided drainage of PO-PFCs is effective but carries the risk of adverse events. Ongoing refinements in the technique and device design appear to have improved safety over time. Careful case selection and early recognition of adverse events are essential for optimizing patient outcomes.

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