Management of Postoperative Pancreatic Fluid Collection and Role of Endoscopy: A Case Series and Review of the Literature

Background: Postoperative fluid collections (POFCs) after abdominal surgeries, particularly pancreatic surgeries, are associated with high morbidity and mortality rates and they were historically managed with surgical re-exploration and drainage. In particular, postoperative pancreatic fluid collections (PPFCs) are the most common complications after pancreatic surgery resulting from pancreatic leak. It occours in up to 50% of cases and apporximately 10% of them need to be drained to avoid further sequelae. Endoscopic UltraSonography (EUS)-guided drainage of PPFCs represents nowadays the first-line treatment, but many aspects are still beated. Methods: We describe a retrospective case series of patients from multiple italian centers who underwent EUS-guided drainage (EUS-D) of POFC, aiming to provide data on efficacy and safety of this procedure, supported by a review of the existing literature on this topic. The primary outcomes were technical and clinical success, and the secondary outcomes were the type and rate of adverse events (AE) and rate of recurrence. Results: A total of 47 patients were included. The procedure demonstrated a technical success of 98% (46/47) and a clinical success of 96% (45/47). The rate of AEs was 11% (5/47), represented by bleeding (3/5), stent occlusion (1/5) and buried syndrome (1/5). Conclusion: Management of POFC has over time shifted towards an endoscopic approach with optimal efficacy and safety.