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Endoscopic treatment of external pancreatic fistulas: when draining the main pancreatic duct is not enough.
- Source :
-
The American journal of gastroenterology [Am J Gastroenterol] 2007 Mar; Vol. 102 (3), pp. 516-24. - Publication Year :
- 2007
-
Abstract
- Objectives: Transpapillary drainage of the main pancreatic duct (MPD) has been proposed for the treatment of external pancreatic fistulas (EPF) but may not suffice to treat complex cases. The aim of the present study was to explore the efficacy of various endoscopic or combined percutaneous and endoscopic techniques in the treatment of EPFs.<br />Methods: Sixteen patients presenting with EPFs were treated in our department. The techniques applied and patients' clinical outcome are described.<br />Results: All but three patients underwent transpapillary MPD drainage by pancreatic sphincterotomy (N = 13). Additional endoscopic procedures performed were: (a) pancreatic fluid collection (PFC) drainage (N = 5), (b) transmural drainage between the fistula path and the gastrointestinal (GI) tract (N = 5), and (c) endoscopic ultrasound (EUS)-guided pancreaticoduodenostomy because of complete pancreatic duct rupture (N = 1). Fistula closure was achieved in all patients except one, who required surgery. During a median follow-up period of 18 months (range 6-52) three patients had fistula recurrence, and two, PFC recurrence. Both conditions were cured successfully by repeated endoscopic therapy. All recurrences occurred within 3 months of initial successful treatment.<br />Conclusions: Combined endoscopic and percutaneous treatment appears to be safe and effective for the management of complex cases of EPFs.
- Subjects :
- Adolescent
Adult
Aged
Endosonography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pancreatic Ducts diagnostic imaging
Pancreatic Fistula diagnostic imaging
Radiography
Retrospective Studies
Treatment Outcome
Drainage methods
Endoscopy, Digestive System methods
Pancreatic Ducts surgery
Pancreatic Fistula surgery
Subjects
Details
- Language :
- English
- ISSN :
- 0002-9270
- Volume :
- 102
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The American journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 17335445
- Full Text :
- https://doi.org/10.1111/j.1572-0241.2006.01014.x