title: Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system.
abstract: BACKGROUND
  Internal pancreatic fistula (IPF) is a well-recognized complication of pancreatic diseases. Although there have been many reports concerning IPF, the therapy for IPF still remains controversial. We herein report our experiences with endoscopic transpapillary pancreatic stent therapy for IPF and evaluate its validity.
  
  
  METHODS
  Six patients with IPF who presented at our department and received endoscopic transpapillary pancreatic stent therapy were investigated, focusing on the clinical and imaging features as well as treatment strategies, the response to therapy and the outcome.
  
  
  RESULTS
  All patients were complicated with stenosis or obstruction of the main pancreatic duct, and in these cases the pancreatic ductal disruption developed distal to the areas of pancreatic stricture. The sites of pancreatic ductal disruption were the pancreatic body in five patients and the pancreatic tail in one patient. All patients received endoscopic stent placement over the stenosis site of the pancreatic duct. Three patients improved completely and one patient improved temporarily. Finally, three patients underwent surgical treatment for IPF. All patients have maintained a good course without a recurrence of IPF.
  
  
  CONCLUSIONS
  Endoscopic transpapillary pancreatic stent therapy may be an appropriate first-line treatment to be considered before surgical treatment. The point of stenting for IPF is to place a stent over the stenosis site of the pancreatic duct to reduce the pancreatic ductal pressure and the pseudocyst's pressure.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
authors.forename: Amane
authors.initials: A
authors.lastname: Kitasato
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Adachi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Ono
authors.forename: Masataka
authors.initials: M
authors.lastname: Hirabaru
authors.forename: Hajime
authors.initials: H
authors.lastname: Matsushima
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology*; D010185:Pancreatic Fistula / Q000473:pathology* / Q000601:surgery*; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000473:pathology / Q000601:surgery; D015203:Reproducibility of Results; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Alcoholic chronic pancreatitis; Endoscopic transpapillary pancreatic stent; Internal pancreatic fistula