Endoscopic transpapillary drainage for external fistulas developing after surgical or radiological pancreatic interventions.
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.
Rana
Surinder Singh
SS
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drsurinderrana@yahoo.co.in
Bhasin
Deepak Kumar
DK
Nanda
Mohit
M
Siyad
Ismail
I
Gupta
Rajesh
R
Kang
Mandeep
M
Nagi
Birinder
B
Singh
Kartar
K
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