US-guided pancreatic duct drainage tied to better outcomes after Whipple surgery

Last Updated: 2016-08-16

By Lorraine L Janeczko

NEW YORK (Reuters Health) - Patients who have endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) following Whipple surgery may do better after those having enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP), a new study suggests.

"Many patients suffer from complications after Whipple surgery that are difficult to manage, including fistula, anastomotic stricture, and recurrent pancreatitis. EUS-PDD shows better efficacy than e-ERP in patients who have had Whipple surgery and the procedure has acceptable safety," said senior author Dr. Mouen A. Khashab of Johns Hopkins Hospital in Baltimore, Maryland.

"In medical centers where adequate expertise with EUS is available, EUS-PDD may be considered to be a first-line treatment for patients needing pancreatic duct drainage after pancreaticoduodenectomy - rather than e-ERP, which has high failure rates even when performed by seasoned endoscopists," Dr. Khashab told Reuters Health by phone.

"The technical and clinical success using EUS-PDD is superior to the success using e-ERP. Also, the higher risk of mild-to-moderate adverse events associated with EUS-PDD needs to be weighed against the low success of e-ERP and the risks of further interventions the patients may need to undergo," he added.

As reported online July 23 in Gastrointestinal Endoscopy, Dr. Khashab and his colleagues compared EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms), and adverse event rates in patients after Whipple surgery.

They analyzed the records of all consecutive patients who underwent EUS-PDD or e-ERP over almost six years at seven tertiary medical centers in the U.S., South America, Europe, and Asia.

The study included 66 patients who had 75 procedures performed, 40 EUS-PDDs and 35 e-ERPs.

In the patients who had EUS-PDD, 92.5% of procedures achieved technical success, compared with 20% of procedures in those who had e-ERP (odds ratio 49.3, p<0.001). Clinical success was achieved in 87.5% of procedures in the EUS-PDD group compared with 23.1% in the e-ERP group (odds ratio 23.3, p<0.001).

Adverse events were reported more commonly in EUS-PDD group (35% vs 2.9%, p<0.001), but all were rated mild or moderate, and procedure time and length of hospital stay were not significantly different between the groups.

"This is, to our knowledge, the first comparative trial to compare EUS-PDD and e-ERCP," Dr. Khashab said by phone. "Its main strength is the relatively large number of patients considered consecutively to limit selection bias and the expertise of the participating medical centers. However, this procedure may be more difficult to apply in smaller and community practices."

He added that the study's limitations include "the treatment of patients at different facilities, the subjective reporting by patients, and its retrospective design."

Dr. Khashab is a consultant for Boston Scientific. The other authors reported no conflicts of interest.

SOURCE: http://bit.ly/2aRsIBr

Gastrointest Endosc 2016.