Background: The shift in surgery is taking place in two directions. On the one hand, it is shifting from open surgery to minimally invasive surgery which will ultimately morph into robot-assisted surgery. On the other hand, the therapeutic possibilities of flexible endoscopy have developed enormously in recent years. Various procedures, such as the debridement of pancreatic necrosis, the resection of early neoplasms, the treatment of achalasia, or the resection of numerous submucosal tumors, have passed into the hands of the interventional endoscopist. Endoscopic procedures have also become established in the management of complications of major intestinal procedures. Despite the fact that endoscopic therapy requires time to heal, for example, in VAC therapy, it being less invasive reduces patient morbidity. Summary: The most common complications in modern pancreatic surgery are pancreatogenic fistulas and fluid collections, as well as insufficiencies of pancreatointestinal or biliodigestive anastomoses. Such complications can be treated endoscopically using methods such as stent placement in the pancreatic or bile duct, endosonographically guided drainage of fluid collections, and even VAC therapy. Key Messages: Endoscopic intervention is the first procedure of choice offered in the treatment of complications in pancreatic surgery. It primarily reduces morbidity in the recovery phase of patients.

1.
Jabłońska
B
,
Mrowiec
S
.
Pancreatectomy and pancreatic surgery
.
Life
.
2023
;
13
(
6
):
1400
.
2.
van Santvoort
HC
,
Besselink
MG
,
Bakker
OJ
,
Hofker
HS
,
Boermeester
MA
,
Dejong
CH
, et al
.
A step-up approach or open necrosectomy for necrotizing pancreatitis
.
N Engl J Med
.
2010
;
362
(
16
):
1491
502
.
3.
van Brunschot
S
,
van Grinsven
J
,
van Santvoort
HC
,
Bakker
OJ
,
Besselink
MG
,
Boermeester
MA
, et al
.
Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial
.
Lancet
.
2018
;
391
(
10115
):
51
8
.
4.
Giuliano
K
,
Ejaz
A
,
He
J
.
Technical aspects of pancreaticoduodenectomy and their outcomes
.
Chin Clin Oncol
.
2017
;
6
(
6
):
64
.
5.
Zhao
X
,
Cui
N
,
Wang
X
,
Cui
Y
.
Surgical strategies in the treatment of chronic pancreatitis: an updated systematic review and meta-analysis of randomized controlled trials
.
Medicine
.
2017
;
96
(
9
):
e6220
.
6.
Ceck
F
,
Jon
B
,
Subrt
Z
,
Ferko
A
.
Surgical technique in distal pancreatectomy: a systematic review of randomized trials
.
BioMed Res Int
.
2014
;
2014
:
482906
.
7.
Andrén-Sandberg
A
,
Ansorge
C
,
Yadav
TD
.
Are there indications for total pancreatectomy in 2016
.
Dig Surg
.
2016
;
33
(
4
):
329
34
.
8.
Nentwich
MF
,
El Gammal
AT
,
Lemcke
T
,
Ghadban
T
,
Bellon
E
,
Melling
N
, et al
.
Salvage completion pancreatectomies as damage control for post-pancreatic surgery complications: a single-center retrospective analysis
.
World J Surg
.
2015
;
39
(
6
):
1550
6
.
9.
Donovan
EC
,
Prakasch
LR
,
Chiang
Y-J
,
Bruno
ML
,
Maxwell
JE
,
Ikoma
N
, et al
.
Incidence of postoperatve complications following pancreatectomy for pancreatic cystic leasonsor pancreatic cancer
.
J Gastrointest Surg
.
2023
;
27
(
2
):
319
27
.
10.
Aghalarov
I
,
Beyer
E
,
Niescery
J
,
Belyaev
O
,
Uhl
W
,
Herzog
T
.
Outcome of combined pancreatic and biliary fistulas after pancreatoduodenectomy
.
HPB
.
2023
;
25
(
6
):
667
73
.
11.
Funamizu
N
,
Sogabe
K
,
Shine
M
,
Honjo
M
,
Sakamoto
A
,
Nishi
Y
, et al
.
Association between the preoperative C-reactive protein-to-albumin ratio and the risk for postoperative pancreatic fistula following distal pancreatectomy for pancreatic cancer
.
Nutrients
.
2022
;
14
(
24
):
5277
.
12.
Peng
Y-P
,
Zhu
X-L
,
Yin
L-D
,
Zhu
Y
,
Wei
J-S
,
Wu
J-L
, et al
.
Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis
.
Sci Rep
.
2017
;
7
(
1
):
185
.
13.
Jabłońska
B
,
Lampe
P
,
Mrowiec
S
.
The influence of nutritional status on the incidence of postoperative complications in patients following distal pancreatectomy
.
Prz Gastroenterol
.
2020
;
15
(
1
):
65
75
.
14.
Marchegiani
G
,
Barreto
SG
,
Bannone
E
,
Sarr
M
,
Vollmer
CM
,
Connor
S
, et al
.
Postpancreatectomy Acute Pancreatitis (PPAP): definition and grading from the International Study Group For Pancreatic Surgery (ISGPS)
.
Ann Surg
.
2022
;
275
(
4
):
663
72
.
15.
Holmberg
M
,
Schou
J
,
Larsson
P
,
Syed
HRS
,
Gilg
S
,
Sparrelid
E
, et al
.
Post-pancreatectomy acute pancreatitis-the new criteria fail to recognize significant presentations
.
J Gastrointest Surg
.
2023
;
27
(
2
):
363
72
.
16.
Mirrielees
JA
,
Weber
SM
,
Abbott
DE
,
Greenberg
CC
,
Minter
RM
,
Scarborough
JE
.
Pancreatic fistula and delayed gastric emptying are the highest-impact complications after Whipple
.
J Surg Res
.
2020
;
250
:
80
7
.
17.
Bassi
C
,
Marchegiani
G
,
Dervenis
C
,
Sarr
M
,
Abu Hilal
M
,
Adham
M
, et al
.
The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after
.
Surgery
.
2017
;
161
(
3
):
584
91
.
18.
Le Moine
O
,
Matos
C
,
Closset
J
,
Devière
J
.
Endoscopic management of pancreatic fistula after pancreatic and other abdominal surgery
.
Best Pract Res Clin Gastroenterol
.
2004
;
18
(
5
):
957
75
.
19.
Malgras
B
,
Dokmak
S
,
Aussilhou
B
,
Pocard
M
,
Sauvanet
A
.
Management of postoperative pancreatic fistula after pancreaticoduodenectomy
.
J Visc Surg
.
2023
;
160
(
1
):
39
51
.
20.
Schorsch
T
,
Müller
C
,
Loske
G
,
Mueller
CT
.
Pancreatico-gastric anastomotic insufficiency successfully treated with endoscopic vacuum therapy
.
Endoscopy
.
2013
;
45
(
Suppl 2 UCTN
):
E141
2
.
21.
Knoop
RF
,
Thimme
R
,
Fischer
A
.
Successful two-sided sponge pull-through treatment of anastomotic leakage following pancreaticoduodenectomy with pancreaticogastrostomy
.
Endoscopy
.
2017
;
49
(
10
):
1010
2
.
22.
Kaczmarek
DJ
,
Heling
DJ
,
Gonzalez-Carmona
MA
,
Strassburg
CP
,
Branchi
V
,
Matthaei
H
, et al
.
Management of post-operative pancreatic fistulas following Longmire-Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
.
BMC Gastroenterol
.
2021
;
21
(
1
):
425
.
23.
Razjouyan
H
,
Maranki
JL
.
Endoscopic retrograde cholangiopancreatography for the management of pancreatic duct leaks and fistulas
.
Gastrointest Endosc Clin N Am
.
2024
;
34
(
3
):
405
16
.
24.
Arvanitakis
M
,
Delhaye
M
,
Bali
MA
,
Matos
C
,
Le Moine
O
,
Devière
J
.
Endoscopic treatment of external pancreatic fistulas: when draining the main pancreatic duct is not enough
.
Am J Gastroenterol
.
2007
;
102
(
3
):
516
24
.
25.
Tilara
A
,
Gerdes
H
,
Allen
P
,
Jarnagin
W
,
Kingham
P
,
Fong
Y
, et al
.
Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections
.
J Am Coll Surg
.
2014
;
218
(
1
):
33
40
.
26.
Koduri
KK
,
Jagtap
N
,
Lakhtakia
S
,
Jahangeer
B
,
Asif
S
,
Talukdar
R
, et al
.
Biflanged metal stents versus plastic stents for endoscopic ultrasound guided drainage of walled-off necrosis: a randomized controlled trial
.
Endoscopy
.
2024
;
56
(
12
):
915
23
.
27.
Varadarajulu
S
,
Trevino
JM
,
Christein
JD
.
EUS for the management of peripancreatic fluid collections after distal pancreatectomy
.
Gastrointest Endosc
.
2009
;
70
(
6
):
1260
5
.
28.
Mukai
T
,
Nakai
Y
,
Hamada
T
,
Matsubara
S
,
Sasaki
T
,
Ishiwatari
H
, et al
.
Early versus delayed EUS-guided drainage for postoperative pancreatic fluid collections: a systematic review and meta-analysis
.
Surg Endosc
.
2024
;
38
(
1
):
47
55
.
29.
Fujimori
N
,
Osoegawa
T
,
Aso
A
,
Itaba
S
,
Minoda
Y
,
Murakami
M
, et al
.
Efficacy of early endoscopic ultrasound-guided transluminal drainage for postoperative pancreatic fistula
.
Can J Gastroenterol Hepatol
.
2021
;
2021
:
6691705
.
30.
Kwon
YM
,
Gerdes
H
,
Schattner
MA
,
Brown
KT
,
Covey
AM
,
Getrajdman
GI
, et al
.
Management of peripancreatic fluid collections following partial pancreatectomy: a comparison of percutaneous versus EUS-guided drainage
.
Surg Endosc
.
2013
;
27
(
7
):
2422
7
.
31.
Miyamoto
R
,
Takahashi
A
,
Ogura
T
,
Kitamura
K
,
Ishida
H
,
Matsudaira
S
, et al
.
Impact of endoscopic ultrasound-guided transmural drainage for postoperative pancreatic fistula after pancreatic surgery
.
DEN Open
.
2024
;
4
(
1
):
e270
.
32.
Jürgensen
C
,
Distler
M
,
Arlt
A
,
Brückner
S
,
Ellrichmann
M
,
Matthes
K
, et al
.
EUS-guided drainage in the management of postoperative pancreatic leaks and fistulas (with video)
.
Gastrointest Endosc
.
2019
;
89
(
2
):
311
9.e1
.
33.
Will
U
,
Füldner
F
,
Reichel
A
,
Meyer
F
.
EUS-guided drainage of the pancreatic duct (EUPD): promising therapeutic alternative to surgical intervention in case of symptomatic retention of the pancreatic duct and unsuccessful ERP
.
Zentralbl Chir
.
2013
;
139
(
3
):
318
25
.
34.
Okamoto
T
,
Gocho
T
,
Futagawa
Y
,
Fujioka
S
,
Yanaga
K
,
Ikeda
K
, et al
.
Does preoperative pancreatic duct stenting prevent pancreatic fistula after surgery? A cohort study
.
Int J Surg
.
2008
;
6
(
3
):
210
3
.
35.
Hosono
K
,
Sato
T
,
Hasegawa
S
,
Kurita
Y
,
Yagi
S
,
Iwasaki
A
, et al
.
Learning curve of endoscopic retrograde cholangiopancreatography using single-balloon enteroscopy
.
Dig Dis Sci
.
2022
;
67
(
7
):
2882
90
.
36.
Schneider
M
,
Höllerich
J
,
Gerges
C
,
Balasus
N
,
Neuhaus
H
,
Beyna
T
.
Motorized spiral enteroscopy-assisted ERCP in surgically altered anatomy: early experience from a retrospective cohort study
.
Endoscopy
.
2023
;
55
(
5
):
476
81
.
37.
Montrsi
RM
,
Zonderhuis
BM
,
Daams
F
,
Busch
OR
,
Kazemier
G
,
Marchegiani
G
, et al
.
Treatment strategies to prevent or mitigate the outcomeof postpancreatectomy hemorrhage: a review of randomized trials
.
Int J Surg
.
2023
;
110
(
10
):
6145
54
.
38.
Wu
X
,
Chen
G
,
Wu
W
,
Zhang
T
,
Liao
Q
,
Dai
M
, et al
.
Management of late hemorrhage after pancreatic surgery: treatment strategy and prognosis
.
J Int Med Res
.
2020
;
48
(
6
):
300060520929127
.
39.
Kim
YH
.
Management and prevention of delayed gastric emptying after pancreaticoduodenectomy
.
Korean J Hepatobiliary Pancreat Surg
.
2012
;
16
(
1
):
1
6
.
40.
Bu
XM
,
Xu
J
,
Dai
XW
,
Ma
K
,
Yang
FQ
,
Hu
J
, et al
.
Is delayed gastric emptying so terrible after pylorus-preserving pancreaticoduodenectomy? Prevention and management
.
World J Gastroenterol
.
2006
;
12
(
39
):
6382
5
.
41.
Vanbrugghe
C
,
Campanile
M
,
Caamaño
A
,
Pol
B
.
Management of delayed stenosis of pancreatico-enteric anastomosis following pancreatoduodenectomy
.
J Visc Surg
.
2019
;
156
(
1
):
30
6
.
42.
Will
U
,
Reichel
A
,
Fueldner
F
,
Meyer
F
.
Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct
.
World J Gastroenterol
.
2015
;
21
(
46
):
13140
51
.
43.
Trieu
JA
,
Seven
G
,
Baron
TH
.
Endoscopic ultrasound-guided pancreatic duct drainage
.
Gastrointest Endosc Clin N Am
.
2024
;
34
(
3
):
501
10
.
44.
Will
U
,
Füldner
F
,
Buechner
T
,
Meyer
F
.
Endoscopic ultrasonography-guided drainage of the pancreatic duct (EUS-PD) in postoperative anastomotic stenosis after previous pancreatic resection
.
Z Gastroenterol
.
2024
;
62
(
12
):
2039
48
.
45.
Samanta
J
,
Chatterjee
A
,
Dhar
J
,
Nabi
Z
,
Bronswijk
M
,
Aggarwal
M
, et al
.
Endoscopic ultrasound-guided pancreatic duct drainage: a comprehensive state of the art review
.
Expert Rev Gastroenterol Hepatol
.
2024
;
18
(
7
):
351
65
.
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