Abstract
Long-Term Outcomes of Endoscopic Treatment of External Pancreatic Fistulas Without Concomitant Pancreatic Fluid Collections
The American journal of gastroenterology, Vol.113(Supplement), pp.S454-S454
10/01/2018
DOI: 10.14309/00000434-201810001-00819
Abstract
Introduction: External pancreatic fistulas (EPFs) are commonly secondary to iatrogenic causes, to include percutaneous drainage of pancreatic fluid collections and pancreatic surgery. Treatment of EPFs has been challenging historically, and often required surgical intervention. We introduced several methods to successfully treat EPFs endoscopically and reduce the need for surgery. Methods: We retrospectively analyzed patients who were treated endoscopically in order to internalize an EPF after resolution of walled-off necrosis (WON) between 2002 and 2018. All patients had evidence of a disconnected pancreatic duct (DPDS) on ERCP or MRCP. Patients were treated by one of 4 techniques: A) Interventional radiology (IR)-guided rendez-vous (RV) through an existing percutaneous drain tract using a TIPS needle into the stomach B) EUS-guided inside-out RV with IR from the stomach into the tract C) Transpapillary RV with IR to "bridge" the pancreatic duct D) Direct EUS-guided access to the fistula with no percutaneous drain in place. In all cases, two 7Fr by 3cm double pigtail plastic stents were placed transmurally into the fistula tract. Results: Thirty patients (22M) with a mean age of 53 (range 24-87) were included. EPFs with a mean output of 230 ml/day (10-1000) were present for a mean 12 months (1-83). Mean duration to resolution of the EPF was 29 days post treatment (1-140). Patients were followed for a mean 32 months (3-112). Twenty patients were treated by technique "A", 7 by technique "B", 3 by technique "C", and 1 case by technique "D" Twenty five patients were treated in one session, the remaining 5 required multiple procedures to succeed in accessing the EPF. One patient was admitted 4 weeks after treatment with small bowel ileus. Another patient with post-procedural fever resolved with antibiotic therapy. There was 1 patient with recurrence of an EPF after 29 months who underwent repeat internalization with technique "A". There were also 4 recurrences of fluid collections (16%) after a mean 8 months (4-9), treated with repeat transgastric endoscopic drainage. No patient required surgery. Conclusion: EPFs in the setting of DPDS can be effectively managed with a variety of techniques, frequently necessitating a multidisciplinary approach with the aid of IR. Clinical resolution can be safely achieved with low rates of recurrence on long-term follow-up and avoidance of surgery.
Details
- Title: Subtitle
- Long-Term Outcomes of Endoscopic Treatment of External Pancreatic Fistulas Without Concomitant Pancreatic Fluid Collections
- Creators
- Nadav SaharMichael GluckRichard KozarekMichael LarsenAndrew RossShayan Irani
- Resource Type
- Abstract
- Publication Details
- The American journal of gastroenterology, Vol.113(Supplement), pp.S454-S454
- Publisher
- Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
- DOI
- 10.14309/00000434-201810001-00819
- ISSN
- 0002-9270
- eISSN
- 1572-0241
- Language
- English
- Date published
- 10/01/2018
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984363176602771
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