Efficacy and safety of endosonography-guided therapy in post-pancreatectomy vs. post-pancreatitis fluid collections: comparative analysis from a high-volume tertiary center

Aims Fluid collections following pancreatic resection (POPFC) have distinct pathogenesis and clinical progression compared to those associated with acute pancreatitis (PFC). Therefore, this study aimed to compare the efficacy and safety of EUS-guided drainage for fluid collections following various types of pancreatic resection versus those from post-pancreatitis origins. Methods Clinical outcome data for patients undergoing EUS-guided therapy for POPFC were collected from 2018 to 2023 at Charité Berlin and compared to outcomes for PFC treated with the same approach. In most cases, 10 French plastic double-pigtail stents were used for drainage in both groups. Clinical endpoints included hospital and ICU length of stay, total number of interventions required for treatment success (including initial procedures, stent removal/replacement, and additional interventions such as necrosectomy or complication management), clinical success of endosonography therapy (defined as reduction of the collection to<50% within 3 months based on follow-up imaging and clinical improvement), 12-month mortality, and complications as defined by the American Society of Gastrointestinal Endoscopy lexicon [ 1 ]. Results The final analysis included 356 patients (71.3% male, mean age 55.6±14.1 years) with pancreatic fluid collections, consisting of 221 with PFC and 135 with POPFC. In the POPFC group, 71 patients (52.6%) had undergone distal pancreatectomy (DP), 33 (24.4%) pylorus-preserving pancreaticoduodenectomy (PPPD), and 16 (11.9%) other resections, including subtotal or total pancreatectomy. Baseline characteristics, including age, gender, comorbidities, and fluid collection features, were comparable between the groups. Double-pigtail plastic stents were used in 302 patients (84.8%), with multiple stents in 42.4% of cases. POPFC patients required fewer reinterventions (median 2, 95% CI 2-2 vs. 4, 95% CI 3-5, p<0.001) and had significantly shorter ICU stays (median 3 days, 95% CI 2-4.2 vs. 14.5 days, 95% CI 9-30, p<0.001) than those with PFC. Subgroup analysis revealed that fluid collections following DP and PPPD had shorter ICU stays (both median 3 days vs. 14.5 days, p<0.001) and higher clinical success rates (92.5% and 92.3% vs. 80.6%, both p<0.05). The PFC group had higher complication (15.8% vs. 7.4%, p<0.05) and mortality rates (9.1% vs. 3%, p<0.05) compared to the POPFC group, except for patients with other types of pancreatic resections including total and subtotal pancreatectomy, who experienced higher complication (18.8%) and mortality rates (12.5%), and prolonged ICU (median 10 days, p<0.05) and hospital stays (median 33.5 days). Conclusions Endosonography-guided therapy is effective and safe for managing POPFC. Fluid collections following DP and PPPD required fewer reinterventions, had shorter ICU stays, and showed higher clinical success rates compared to post-pancreatitis cases. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany