title: Early dual drainage combining transpapillary endotherapy and percutaneous catheter drainage in patients with pancreatic fistula associated with severe acute pancreatitis.
abstract: BACKGROUND
  The development of pancreatic fistula (PF) associated with pancreatic necrosis is of great concern in the management of severe acute pancreatitis (SAP). We expected that early recognition and intervention of PF combined with percutaneous catheter drainage (PCD) for pancreatic infection may improve SAP outcomes.
  
  
  METHODS
  Fifteen consecutive patients with SAP were enrolled. Whenever feasible, fine-needle aspiration for fluid collection was performed to determine infection and amylase concentration. For infection and PF with amylase-rich fluid, PCD and transpapillary endotherapy (preferably naso-pancreatic drainage) were carried out as soon as possible. PCD was intensively managed by irrigating the sized-up and multiple large bore catheters.
  
  
  RESULTS
  Infected fluid collection and PF were both detected in 13 (86.7%) patients. Pancreatic duct (PD) disruption (n = 6) and organ failure (n = 5) occurred exclusively in patients with amylase-rich collection ≥10,000 U/L. The median timing of PCD and endotherapy was 15.5 and 16.5 days, respectively. No serious complications or mortality resulted from intervention procedures other than stent occlusion in one (6.7%) patient. Surgical intervention due to uncontrollable infection and visceral organ injury was avoided. Fistula closure was achieved in 12 (92.3%) of 13 PF patients with a median duration of 45 days. Disease-related mortality occurred in one (6.7%) patient.
  
  
  CONCLUSIONS
  Amylase-rich fluid collection ≥10,000 U/L may be an indication for further endoscopic investigation of PD disruption. Early dual drainage combining pancreatic endotherapy and PCD is feasible and safe, and may improve treatment outcome.
authors.affiliation: Department of Surgery, Shinshiro Municipal Hospital, 32-1 Kitahata, Shinshiro, Aichi 441-1387, Japan. Electronic address: y.yokoi@shinshirohp.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yokoi
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1 Kita-andoh, Aoi-ku, Shizuoka, Shizuoka 425-8527, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kikuyama
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1 Kita-andoh, Aoi-ku, Shizuoka, Shizuoka 425-8527, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kurokami
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, 4-27-1 Kita-andoh, Aoi-ku, Shizuoka, Shizuoka 425-8527, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis; D044963:Biopsy, Fine-Needle / Q000009:adverse effects / Q000379:methods; D001826:Body Fluids / Q000201:enzymology; D002404:Catheterization; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D009296:Nasal Cavity; D010183:Pancreatic Ducts / Q000473:pathology; D010185:Pancreatic Fistula / Q000209:etiology* / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000681:Amylases
keywords: Amylase concentration; Naso-pancreatic drainage; Pancreatic duct disruption; Pancreatic fistula; Percutaneous catheter drainage; Severe acute pancreatitis