Endoscopic Treatment of Postsurgical External Pancreatic Fistulas

Costamagna, Guido; Mutignani, Massimiliano; Ingrosso, M.; Vamvakousis, V.; Alevras, Petros P.; Manta, Raffaele; Perri, Vincenzo

doi:10.1055/s-2001-13695

Cited by 90 publications

(58 citation statements)

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“…Some believe intraductal pancreatic stents might reduce postoperative complications after pancreatic resections [13][14][15] . Furthermore, pancreatic stents are used in the treatment of chronic pancreatitis induced ductal strictures [16] .…”

Section: Discussionmentioning

confidence: 99%

Biocompatibility of a New Bioabsorbable Radiopaque Stent Material (Ba SO4 Containing Poly-L,D-Lactide) in the Rat Pancreas

et al. 2006

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Section: Discussionmentioning

confidence: 99%

Biocompatibility of a New Bioabsorbable Radiopaque Stent Material (Ba SO4 Containing Poly-L,D-Lactide) in the Rat Pancreas

et al. 2006

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“…The first report of the use of pancreatic stents in the treatment of internal and external pancreatic fistulae was published in 1993 [55]and the success rate in more recent series has been 75–100% with an average success rate of 40 (85%) in 47 patients (table 5). The technique comprises the placement of a small (5–7 French) diameter stent of variable length or a nasopancreatic drain into the main pancreatic duct and preferably across the site of ductal disruption [17, 49, 56, 57]. Stents are retrieved 10–14 days after external fistula closure.…”

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

102

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Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.

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“…If there is a stone in the duct, extracorporeal shockwave lithotripsy can be used before ERCP, following removal of the stone fragments. The results of the endoscopic studies in the treatment of pancreaticocutaneous fistulas, postoperative fistulas, pancreaticopleural fistulas, peripancreatic fluid collections, and pancreatic ascites have been encouraging [1,[15][16][17][18][19]21]. Up to 90% of the patients with pancreatic fistulas can be successfully treated endoscopically with minimal complications and no procedure-related mortality.…”

Section: Endoscopic Interventionsmentioning

confidence: 95%

“…A later surgery for fistula is technically demanding and is associated with major morbidity and mortality. The role of therapeutic endoscopy in the treatment of pancreatic diseases has been expanding in the past 15 years [15][16][17][18][19][20]. There has been a trend towards a more active and earlier endoscopic approach, as it has seemed beneficial and a worthy replacement to longer-term conservative treatment.…”

Section: Endoscopic Interventionsmentioning

confidence: 99%