title: Endoscopic transpapillary drainage for external fistulas developing after surgical or radiological pancreatic interventions.
abstract: OBJECTIVE
  External pancreatic fistulas (EPFs) are a therapeutic challenge. The present study was conducted to evaluate the efficacy of endoscopic transpapillary nasopancreatic drainage (NPD) in patients with EPF.
  
  
  METHODS
  Over 12 years, 23 patients (19 males) with EPF underwent attempted endoscopic transpapillary NPD. The end points were fistula closure with healing of pancreatic duct disruption on nasopancreatogram, or need for surgery.
  
  
  RESULTS
  All 23 patients had persistent drain output (>50 mL/day) for >6 weeks. The mean output volume of the fistula was 223 mL (range: 60 mL to 750 mL). Sixteen patients had partial and seven patients had complete pancreatic duct disruption. The NPD could be successfully placed in 21/23 (91.3%) patients. Disruption was bridged in 15 of 16 patients with partial duct disruption. EPF healed in 2-8 weeks of placement of NPD in all of the patients with partial duct disruption that was bridged and there was no recurrence at a mean follow-up of 38 months. The EPF resolved in only 2/6 (33%) patients with complete duct disruption.
  
  
  CONCLUSIONS
  External pancreatic fistulas developing following percutaneous drainage of pancreatic fluid collections or surgical necrosectomy can be effectively treated by transpapillary nasopancreatic drain placement especially when there is partial ductal disruption and the disruption can be bridged.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drsurinderrana@yahoo.co.in
authors.forename: Surinder Singh
authors.initials: SS
authors.lastname: Rana
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Bhasin
authors.forename: Mohit
authors.initials: M
authors.lastname: Nanda
authors.forename: Ismail
authors.initials: I
authors.lastname: Siyad
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kang
authors.forename: Birinder
authors.initials: B
authors.lastname: Nagi
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D015641:Radiography, Interventional / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult