title: Endoscopic transpapillary stenting or conservative treatment for pancreatic fistulas in necrotizing pancreatitis: multicenter series and literature review.
abstract: OBJECTIVE
  Endoscopic transpapillary stenting (ETS) of the pancreatic duct facilitates ductal outflow and may reduce time to pancreatic fistula closure. However, data on the feasibility of ETS in patients with necrotizing pancreatitis are scarce.
  
  
  BACKGROUND
  Pancreatic fistulas often occur after intervention in necrotizing pancreatitis and frequently close only after months of conservative treatment.
  
  
  METHODS
  From a prospective cohort of patients with acute pancreatitis admitted in 15 hospitals (2004-2007), all patients who underwent ETS or conservative treatment for a pancreatic fistula were identified. Safety, feasibility, and outcome of ETS were evaluated. Furthermore, a literature review was performed for similar studies in necrotizing pancreatitis.
  
  
  RESULTS
  Of 731 patients with acute pancreatitis, 19 patients were treated with ETS and 16 patients were treated conservatively for a pancreatic fistula. Fistula closure was achieved in 16 of 19 patients (84%) in the ETS group and in 8 of 12 patients (75%) in the conservative group (P = 0.175). The median time to fistula closure after ETS was 71 days (interquartile range [IQR] 34-142) compared with 120 days (IQR 51-175 days) in the conservative group (P = 0.130). Complications were observed in 6 patients. A total of 10 studies reporting the results of 281 patients with stent placement for pancreatic fistulas were included in the literature review. Fistula closure was achieved in 200 patients (71%). Stent-related complications were reported in 9% of patients.
  
  
  CONCLUSIONS
  ETS seems a feasible and safe alternative to conservative treatment in patients with pancreatic fistulas after intervention for necrotizing pancreatitis.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. o.j.bakker@umcutrecht.nl
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.forename: Mark C
authors.initials: MC
authors.lastname: van Baal
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: Joos
authors.initials: J
authors.lastname: Heisterkamp
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome