Endoscopic transpapillary nasopancreatic drainage alone to treat pancreatic ascites and pleural effusion.
BACKGROUND
Pancreatic ascites and pleural effusion are uncommon sequelae of pancreatitis and are associated with significant morbidity and mortality. Endoscopic decompression of the pancreatic duct through transpapillary stent or nasopancreatic drain (NPD) has shown encouraging results but the experience is limited. The aim of the present study was to evaluate the efficacy of endoscopic transpapillary nasopancreatic drainage in patients with pancreatic ascites and pleural effusion.


METHODS
Over a period of 9 years, 10 patients (eight male) with pancreatic ascites and/or pleural effusion with pancreatic duct disruption documented on pancreatogram were studied. After informed consent, endoscopic transpapillary NPD was placed. The end-points were resolution of ascites and/or pleural effusion or need for surgery.


RESULTS
Of 10 patients (age range: 13 months-46 years), four patients had only ascites, four had only pleural effusion and two had both ascites and pleural effusion. Ascites and/or pleural effusion resolved in all the patients within 4 weeks of placement of NPD. The healing of ductal disruption was demonstrated by nasopancreatogram as early as 2 weeks and NPD could be removed without necessitating another endoscopy. No major complications related to NPD placement were noted. There was no recurrence of pancreatic ascites and/or pleural effusion at a mean follow up of 39 months.


CONCLUSIONS
Pancreatic ascites and pleural effusion can be effectively treated by endoscopic retrograde pancreatography and transpapillary NPD placement.
Bhasin
Deepak Kumar
DK
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160023, India.
Rana
Surinder Singh
SS
Siyad
Ismail
I
Poddar
Ujjal
U
Thapa
Babu Ram
BR
Sinha
Saroj Kant
SK
Nagi
Birinder
B
D000293:Adolescent; D000328:Adult; D001201:Ascites / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000601:surgery*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed