Preoperative EUS elastography: A new tool for predicting postoperative pancreatic fistulas

Abstract

. ABSTRACT Background: Post-operative Pancreatic fistula (POPF) is one of the significant serious complications following a PancreaticoDudenectomy (PD) or Distal Pancreatectomy (DP), and its incidence ranges from 13 to 50%. Identification of patients at a greater risk could assist in tailoring the management approach, which may involve implementing different methods for anastomotic techniques, placing additional drainage, and using somatostatin analogues as a preventive measure. Objectives: Assessing the stiffness of the pancreas using EUS elastography before surgery is an objective, quantitative, and dependable method. This detailed evaluation prior to surgery could enable surgeons to personalize and adjust the management plan in the perioperative period, leading to the best possible outcomes. Patients and Methods: This prospective case series study was conducted in Cairo University (Kasr Al-Aini Hospital) over a 12-month period between April 2021 and March 2022. Fifty-one patients underwent pancreatic surgeries either PD or DP were enrolled into the study. EUS was done for all patients by the same operator using pentax 3870 attached to a HITACHI Avius sonographic machine. Elastography was performed for all patients in two different points of pancreas and the mean was taken for both. The reading was translated to soft, intermediate, hard texture of pancreas where soft was ≤1.40 m/s, intermediate was >1.40 m/s but ≤2 m/s, hard was >2 m/s. Amylase in drain was done at day 1, 3, 5 postoperative. Results: A statistically significant correlation was observed between presence of pancreatic fistula and EUS findings, as soft pancreas showed higher significant prevalence of pancreatic fistula ( P=0.030 ). On the other hand, grade A fistula was higher in cases with soft and intermediate stiffness but did not reach the significance level ( P=0.053 ). By using ROC-curve analysis, EUS elastography can insignificantly predict postoperative pancreatic fistula in patients undergoing pancreatic surgeries at cutoff 2.0 m/s with sensitivity, specificity, PPV and NPV was 95.2%, 30.0%, 57.6% and 86.2% respectively ( P=0.514 ). Conclusion: The current research showed that pancreatic stiffness could be measured by preoperative elastography. Moreover, we discovered that the elastic ratio can be employed to detect a ‘soft pancreas’. This information is valuable as it can help predict the probability of POPF following pancreatectomy.