Outcomes of endoscopic ultrasound-guided transmural drainage for postoperative peripancreatic fluid collection with an external drainage-first approach

ObjectivesEndoscopic ultrasound-guided transmural drainage (EUS-TD) is widely performed to treat postoperative peripancreatic fluid collection (POPFC). Recent reports on EUS-TD lack a consensus on stent selection. This study aimed to assess the efficacy of EUS-TD for POPFC using an external drainage-first approach. MethodsWe retrospectively examined the medical records of patients with POPFC treated with EUS-TD using external drainage between October 2016 and July 2024. Technical success was defined as successful placement of the external drainage. Clinical success was defined as the disappearance of fluid collection on follow-up computed tomography without additional intervention. ResultsThis study included 14 patients. The median duration from surgery to endoscopic treatment was 13 (range: 11-26) days. The median procedural time was 26 (range: 13-35) min. The technical success rate was 100%, and 6 Fr endoscopic nasocystic drainage was performed in all patients. The clinical success rate was 64.3%, and no adverse events were observed. In 35.7% (5/14) of the patients, additional endoscopic internal drainage was required; the POPFC was successfully controlled in all patients. The reasons for conversion to internal drainage were prolonged inflammation in one patient, remaining fluid collection in one patient, and requests from surgeons in three patients. ConclusionsEUS-TD for POPFC with external drainage proved to be safe and effective, with a short procedure time. However, in certain patients, additional internal drainage is required.