title: Endoscopic transpapillary stenting for pancreatic fistulas after necrosectomy with necrotizing pancreatitis.
abstract: BACKGROUND
  Data concerning the incidence and treatment of pancreatic fistula after necrosectomy in severe acute necrotizing pancreatitis (SAP) are scarce. Our aim was to assess the incidence of pancreatic fistula, and the feasibility and results of endoscopic transpapillary stenting (ETS) in patients with SAP after necrosectomy.
  
  
  METHODS
  From January 2009 to December 2012 twenty-nine consecutive patients with SAP and necrosectomy in Oulu University Hospital were enrolled into this study. Five patients died before ETS because of the rapid progress of the disease and were, therefore, excluded.
  
  
  RESULTS
  ERP was performed for the remaining 24 patients demonstrating fistula in 22/24 patients (92 %). ETS was successful in 23 patients and the fistula closed in all of them after a median of 82 (2-210) days with acceptable morbidity and no procedure-related mortality.
  
  
  CONCLUSIONS
  All patients after necrosectomy for SAP seem to have internal or external pancreatic fistula. EST aimed at internal drainage of the necrosectomy cavity is a feasible and effective therapy in these patients.
authors.affiliation: Gastrointestinal Surgery Division, Department of Surgery, Oulu University Hospital, OYS, BOX 21, 90029, Oulu, Finland, heikki.karjula@ppshp.fi.
authors.forename: Heikki
authors.initials: H
authors.lastname: Karjula
authors.forename: Arto
authors.initials: A
authors.lastname: Saarela
authors.forename: Anne
authors.initials: A
authors.lastname: Vaarala
authors.forename: Jarmo
authors.initials: J
authors.lastname: Niemelä
authors.forename: Jyrki
authors.initials: J
authors.lastname: Mäkelä
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome