Endoscopic against radiologic drainage of fistula collections after distal pancreatectomy

Design

Retrospective single-centre cohort

Population

94 patients with symptomatic fistula-associated collections after distal pancreatectomy; 25 endoscopic vs 12 radiologic drainage

Primary outcome

Total hospital stay within 90 days including readmissions

Effect

19 vs 31 days (P = 0.023); clinical success 76% vs 50% (P = 0.15)

This retrospective single-centre study covered 607 distal pancreatectomies from 2012 to 2024. Pancreatic fistula occurred in 124 patients (20.4%), and 94 (15.5%) had a symptomatic collection. Twenty-five had first-line endoscopic drainage, mostly with lumen-apposing metal stents, and 12 had radiologic drainage.

Total hospital stay within 90 days, counting readmissions, was 19 days after endoscopic drainage and 31 after radiologic drainage (P = 0.023). Clinical success was 76% against 50% (P = 0.15, not significant), and drainage dysfunction 4% against 17% (P = 0.2). There were four severe complications, three after endoscopic stents, two of them bleeding.

The groups differed in collection location, with 92% of endoscopic cases next to the transection margin against 50%, and the numbers are small. Endoscopic drainage is an option where an expert endoscopist is available, with attention to bleeding.

• Consider endoscopic drainage for collections next to the pancreatic transection margin if expertise exists.
• Anticipate bleeding after lumen-apposing stents and plan imaging and stent removal.
• Radiologic drainage remains reasonable for collections not reachable endoscopically.
• Count readmissions when you audit total hospital stay.

Why it matters

The choice of drainage route after pancreatic resection is made on local habit, and this adds weak evidence for the endoscopic route.

Don't overread it

This was retrospective, from one centre, with 37 patients in the comparison, so it cannot show endoscopic drainage is better.

The statistics, in plain English

Only 37 patients were compared, and the groups differed in collection site, which itself was linked to shorter stay. The success and dysfunction differences had P values above 0.05, so they could be chance.

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