title: Efficacy of the double-pigtail stent as a conservative treatment for grade B pancreatic fistula after pancreatoduodenectomy with pancreatogastric anastomosis.
abstract: BACKGROUND
  Despite improvements in surgical techniques and postoperative care, morbidity associated with pancreatoduodenectomy (PD) is still high. Grade B pancreatic fistula (PF) requires a specific combination of radiologically guided external drainage and medical support. This treatment is effective but requires prolonged hospitalization and maintenance of external drainage. The objective of this study was to evaluate the feasibility and efficacy of a double-pigtail stent (DPS) to treat grade B PF after PD with pancreatogastric anastomosis.
  
  
  METHODS
  Between January 2008 and October 2011, all patients who presented grade B PF after PD (n = 6) were included in the study. The PF was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula. Endoscopic treatment was standardized with a DPS. The primary efficacy end point was the feasibility and efficacy of DPS placement. Secondary end points included data on the PF, the DPS placement procedure, and long-term outcome.
  
  
  RESULTS
  Endoscopic DPS placement was achieved in all patients with no complications. The median time to onset of PF after PD was 14 days. Closure of the external PF was obtained 7 days after the introduction of the DPS. The median time to external drain removal was 7 days after DPS placement, and the median time to oral refeeding was 7 days after DPS placement for all patients. The median time to DPS removal was 60 days. The median length of hospital stay after DPS placement was 10 days. During a median follow-up period of 21 months, there was no recurrence of PF after removal of the DPS.
  
  
  CONCLUSIONS
  Endoscopic treatment of grade B PF after PD appears to be effective and safe and is associated with shorter hospitalization.
authors: Department of Gastroenterology, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
authors: Eric
authors: E
authors: Bartoli
authors: Lionel
authors: L
authors: Rebibo
authors: Brice
authors: B
authors: Robert
authors: Mathurin
authors: M
authors: Fumery
authors: Richard
authors: R
authors: Delcenserie
authors: Jean-Marc
authors: JM
authors: Regimbeau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013270:Stomach / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome