Endoscopic management of pancreatic fistula after pancreatic and other abdominal surgery.
Post-operative pancreatic fistulae represent a challenge for all the actors in gastroenterology: for surgeons, because they want to prevent and treat conservatively this complication since re-operation is associated with high morbidity and mortality rates; for radiologists, because they have to provide the best staging and informations without any additional risk; and for endoscopists, because endoluminal treatment is emerging as a safe and effective procedure provided it is performed in highly experienced tertiary centres in the setting of a multidisciplinary approach. Herein, we review the definitions, the causes, the staging and the possible options to prevent or treat post-operative pancreatic fistulae. Special attention is paid to the endoscopic management of this complication: including the relief of ductal obstructions, the stenting of leakages and the drainage of bulging or non-bulging fluid collections. Practical problems and issues are clearly outlined as well as the need for future improvements in staging and management of the patients having such complications.
Le Moine
Olivier
O
Department of Gastroenterology, ULB-Hôpital Erasme, 808 route de lennik, B-1070 Brussels, Belgium. olemoine@ulb.ac.be
Matos
Celso
C
Closset
Jean
J
Devière
Jacques
J
D049448:Cholangiopancreatography, Magnetic Resonance; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004322:Drainage; D016145:Endoscopy, Digestive System; D019160:Endosonography; D006801:Humans; D010183:Pancreatic Ducts; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D010195:Pancreatitis / Q000150:complications; D015642:Radiology, Interventional; D015607:Stents; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed