title: Incidence of pancreatic fistula after distal pancreatectomy and efficacy of endoscopic therapy for its management: results from a tertiary care center.
abstract: Pancreatic fistula is a known complication of distal pancreatectomy. Endotherapy with pancreatic duct stent placement and pancreatic sphincterotomy has been shown to be effective in its management; however, experience of endotherapy in the management of this complication has not been extensively reported from the United States. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent placement has also been proposed to prevent this complication after distal pancreatectomy. In our cohort of 59 patients who underwent distal pancreatectomy, 13 (22%) developed a pancreatic fistula in the immediate postoperative period, of whom 8 (14%) patients (5 female, mean age 52 years) were referred for an ERCP because of ongoing symptoms related to the pancreatic fistula. The pancreatic fistula resolved in all patients after a median duration of 62 days from the index ERCP. The median number of ERCPs required to document resolution of the pancreatic fistula was 2. Although a sizeable percentage of patients develop a pancreatic fistula after distal pancreatectomy, only a small percentage of patients require ERCP for management of this complication. Given the high success rate of endotherapy in resolving pancreatic fistula and the fact that the majority of patients who undergo distal pancreatectomy never require an ERCP, performing ERCP for prophylactic pancreatic duct stent prior to distal pancreatectomy might not be necessary.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebr., USA.
authors.forename: Savio C
authors.initials: SC
authors.lastname: Reddymasu
authors.forename: Kavous
authors.initials: K
authors.lastname: Pakseresht
authors.forename: Brian
authors.initials: B
authors.lastname: Moloney
authors.forename: Benjamin
authors.initials: B
authors.lastname: Alsop
authors.forename: Melissa
authors.initials: M
authors.lastname: Oropezia-Vail
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Olyaee
keywords: Distal pancreatectomy; Pancreatic duct stenting; Pancreatic fistula; Pancreatic leak
references.citation: Ann Surg. 1999 May;229(5):693-8; discussion 698-700
references.pmid: 10235528
references.citation: Arch Surg. 2008 Oct;143(10):956-65
references.pmid: 18936374
references.citation: Gastrointest Endosc. 2010 Sep;72(3):536-42
references.pmid: 20598301
references.citation: Arch Surg. 2006 Apr;141(4):361-5; discussion 366
references.pmid: 16618893
references.citation: Am J Surg. 2009 Jun;197(6):715-20
references.pmid: 18789426
references.citation: Gastrointest Endosc. 2006 Mar;63(3):378-82; quiz 464
references.pmid: 16500382
references.citation: Arch Surg. 2001 Apr;136(4):391-8
references.pmid: 11296108
references.citation: Chirurg. 2002 May;73(5):466-73
references.pmid: 12089831
references.citation: J Gastrointest Surg. 2008 May;12(5):882-90
references.pmid: 18273671
references.citation: Endoscopy. 2001 Apr;33(4):317-22
references.pmid: 11315892
references.citation: Surgery. 2005 Feb;137(2):180-5
references.pmid: 15674199
references.citation: J Hepatobiliary Pancreat Surg. 2008;15(4):373-6
references.pmid: 18670837
references.citation: Am Surg. 2009 Aug;75(8):654-7; discussion 657-8
references.pmid: 19725286
references.citation: Ann Surg. 2003 Jan;237(1):57-65
references.pmid: 12496531
references.citation: Am J Surg. 2002 Mar;183(3):237-41
references.pmid: 11943118