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

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Title: Endoscopic ultrasound-guided transmural drainage for pancreatic fistula or pancreatic duct dilation after pancreatic surgery
Authors: Onodera, Manabu Browse this author
Kawakami, Hiroshi Browse this author →KAKEN DB
Kuwatani, Masaki Browse this author →KAKEN DB
Kudo, Taiki Browse this author
Haba, Shin Browse this author
Abe, Yoko Browse this author
Kawahata, Shuhei Browse this author
Eto, Kazunori Browse this author
Nasu, Yuya Browse this author
Tanaka, Eiichi Browse this author
Hirano, Satoshi Browse this author →KAKEN DB
Asaka, Masahiro Browse this author →KAKEN DB
Keywords: EUS-guided drainage
EUS-guided transmural drainage
Pancreatic fistula
Pancreatic surgery
Stasis of pancreatic juice
Issue Date: Jun-2012
Publisher: Springer New York
Journal Title: Surgical Endoscopy
Volume: 26
Issue: 6
Start Page: 1710
End Page: 1717
Publisher DOI: 10.1007/s00464-011-2097-z
PMID: 22179480
Abstract: 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 dilation of the main pancreatic duct visible by EUS. Eighteen patients (6.8%) received percutaneous drainage. The success rates for EUS-TD and percutaneous drainage were compared in a retrospective analysis. Results: EUS-RD 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 for 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.
Rights: The original publication is available at www.springerlink.com
Type: article (author version)
URI: http://hdl.handle.net/2115/52926
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 河上 洋

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