Predictors of clinical success in endoscopic ultrasound-guided drainage of postoperative pancreatic fluid collections

Background and aims: Endoscopic ultrasound (EUS)-guided drainage is increasingly used for the management of postoperative pancreatic fluid collections (POPFC). We aimed to identify factors associated with clinical success, and to perform exploratory analyses of outcomes stratified by surgery type and stent type. Patients and methods: We performed a retrospective multicenter cohort study including patients who underwent EUS-guided drainage of POPFC following pancreatic surgery between 2014 and August 2024 at three academic centers. The primary outcome was clinical success, defined as combined radiological and clinical resolution without the need for percutaneous or surgical step-up intervention. Results: A total of 265 patients were included (mean age 64±14 years; 57% male; 52% underwent drainage ≤14 days after surgery, necrotic component in 51%). Clinical success was achieved in 194 patients (73%; 95% CI 67.5–78.1%), including 160 (60%; 95% CI 54.5–66.3%) after a single procedure and 34 after additional endoscopic reinterventions, while 20 patients (7.6%; 95% CI 4.4–10.7%) required percutaneous or surgical step-up. Distal pancreatectomy, compared with pancreaticoduodenectomy, was associated with a higher rate of reintervention (32% vs. 20%, p=0.02) and independently associated with lower odds of clinical success (odds ratio 0.53, 95% confidence interval 0.29–0.98; p=0.04). Conclusions: EUS-guided drainage for POPFC appears effective, with an acceptable safety profile in expert centers, achieving clinical resolution in the majority of patients. Distal pancreatectomy was associated with a more complex treatment course. These findings support the use of EUS-guided drainage as a central component in the management of POPFC.