Title: Endoscopic treatment of external pancreatic f istulas
- Marian Smoczyński, Iwona Marek, Michał Dubowik, Grażyna Rompa, Joanna Pieńkowska
- Original articles
- Polish Gastroenterology
- Start page:
- Final page:
- pancreatic fistula, endoscopic treatment
Introduction: External pancreatic fistulas are relatively frequent complications following pancreatic surgery, abdominal trauma or acute bout of pancreatitis. The channel of external pancreatic fistula usually runs along the line of incision or is a residue after percutaneous drainage. The fistula occurrence is usually connected with pancreatic duet stricture, pancreatic stone or both. lf conservative treatment fails the endoscopic procedures are performed including: sphincterotomy, dilation of distal pancreatic strictures and stenting.
Material and methods: Endoscopic treatment of external pancreatic fistulas was performed in 7 patients hospitalized in our Department. The cause of panereatic ocutaneous fistula development was: necrosectomy in 4 patients, abdominal trauma in 1 patient, complication after pancreatic taił resection in 1 patient, external drainage of infected pancreatic cyst in 1 patient. In all patients the abnormality of pancreatic duet (p.d.) was confirmed in endoscopic retrograde pancreatography (ERP). Pancreatic sphincterotomy was performed in all patients. Stricture of p.d. was dilated endoscopically. The duration of fistula closure was 15-39 days. Endoprostheses were exchanged every 3 months on the average till obtaining normal contrast out flow from p.d.
Results: The duration of p.d. stenting was 31-294 days. The meanobservation period was 23 months. Neither fistula recurrence nor any complication of endoscopic procedures were seen in any patients.
Conclusions: We conclude that endoscopic treatment of external pancreatic fistulas is an effective and safe method, pancreatic duet drainage should be continued until full tightness of the duet is achieved and qualification for endoscopic treatment of external pancreatic fistulas ought to be based on the result of ERP.