title: Endoscopic treatment of external pancreatic fistulas: when draining the main pancreatic duct is not enough.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Sixteen patients presenting with EPFs were treated in our department. The techniques applied and patients' clinical outcome are described.
  
  
  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.
  
  
  CONCLUSIONS
  Combined endoscopic and percutaneous treatment appears to be safe and effective for the management of complex cases of EPFs.
authors.affiliation: Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium.
authors.forename: Marianna
authors.initials: M
authors.lastname: Arvanitakis
authors.forename: Myriam
authors.initials: M
authors.lastname: Delhaye
authors.forename: Maria-Antonietta
authors.initials: MA
authors.lastname: Bali
authors.forename: Celso
authors.initials: C
authors.lastname: Matos
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Moine
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome