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Updated: Nov 19, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Effectiveness of early endoscopic ultrasound-guided drainage for postoperative fluid collection
Dongwook Oh1, Hwaryong Lee2, Tae Jun Song1
1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
Insights
Early endoscopic ultrasound (EUS)-guided drainage of postoperative abdominal fluid collections (PAFCs) within 4 weeks of surgery is effective and safe. This minimally invasive approach offers a high success rate for managing early-onset PAFCs.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Interventional Endoscopy
Background:
- Postoperative abdominal fluid collections (PAFCs) are a serious complication following pancreatobiliary surgery.
- While EUS-guided drainage is established for older PAFCs (>4 weeks), its efficacy in early-onset collections (<4 weeks) is less understood.
Purpose of the Study:
- To evaluate the efficacy and safety of early endoscopic ultrasound (EUS)-guided drainage for PAFCs developing within 4 weeks after pancreatobiliary surgery.
Main Methods:
- Retrospective analysis of 48 patients undergoing EUS-guided PAFC drainage within 4 weeks of surgery.
- Data collected from a prospectively maintained EUS database and electronic medical records.
Main Results:
- Technical success was achieved in all 48 patients.
- Clinical success rate was 95.8% (46/48), with a median resolution time of 23.5 days.
- Adverse events were rare (2 cases of intracystic bleeding), successfully managed conservatively.
Conclusions:
- Early EUS-guided drainage is a technically feasible, effective, and safe intervention for PAFCs within 4 weeks of pancreatobiliary surgery.
- This approach provides a high success rate and favorable safety profile for managing early postoperative fluid collections.
Background:
Postoperative abdominal fluid collections (PAFCs) are a potentially fatal complication of pancreatobiliary surgery. Endoscopic ultrasound (EUS)-guided drainage has recently been shown to be effective in treating PAFCs of more than 4 weeks old. Little is currently known, however, regarding the EUS-guided drainage of PAFCs of less than 4 weeks. This study assessed the efficacy and safety of the early drainage (< 4 weeks) of PAFCs via EUS guidance.
Methods:
The data of patients who had undergone EUS-guided PAFC drainage between July 2008 and January 2018 were retrospectively analyzed. Data of EUS-guided PAFC drainage were obtained from prospectively collected EUS database of our institute and reviewed of patients' clinical parameters based on electrical medical record.
Results:
A total of 48 patients who had undergone EUS-guided PAFC drainage within 4 weeks of pancreatobiliary surgery were enrolled. The indications of procedure included abdominal pain (n = 27), fever (n = 18), leukocytosis (n = 2), and increased size of PAFC during external tube drainage (n = 1). Technical success was achieved in all cases, and the clinical success rate was 95.8% (46/48). Four patients underwent secondary procedures. The median period from surgery to EUS-guide drainage was 14 days (Interquartile range [IQR] 10-16), and median time to resolution was 23.5 days (IQR 8.5-33.8). Adverse events occurred in two cases that were developed intracystic bleeding and were successfully resolved by arterial coil embolization.
Conclusions:
Early EUS-guided drainage is a technically feasible, effective, and safe method in patients who have developing PAFCs within 4 weeks of pancreatobiliary surgery.
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