Resolution of pancreatico-pleural fistula with endoscopic ultrasound-guided therapy

Houlihan, Matthew; Bowyer, Brad A.; Barclay, Robert L.

doi:10.1016/j.rmcr.2013.05.001

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…The main motive of stent placement other than decompressing the duct is to bridge the site of duct disruption if possible as most fistulae appear to arise from head or body of the pancreas and are thus amenable to bridging with a pancreatic stent. Most stents used are either 5 Fr or 7 Fr size we used 7Fr stent which resulted in decreasing the pleural effusion as fistulae from a pseudocyst which are no longer in communication with pancreatic ductal system heal spontaneously [12,13].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic pleural effusion masquerading as right sided tubercular pleural effusion

Chawla

Chauhan

Dutt

et al. 2019

Monaldi Arch Chest Dis

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Pleural effusion is easily diagnosed often managed optimally with standard protocols. It at times, is a diagnostic dilemma as it comes with big list of differential diagnosis. Pleural effusion due to pancreaticopleural fistula (PPF) is a rare and on right side is even rarer. Detailed history along with high index of suspicion in required to diagnose PPF, which is confirmed by increased level of pleural fluid amylase and lipase along with magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) demonstrating fistula tract. Here we report the case of a young patient who presented with respiratory distress and was wrongly diagnosed as right sided tubercular effusion which later turned out to be pancreatic effusion. Management in our case was multi-disciplinary involving pulmonologist, gastroenterologist, radiologist and thoracic surgeon.

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Section: Discussionmentioning

confidence: 99%

Pancreatic pleural effusion masquerading as right sided tubercular pleural effusion

Chawla

Chauhan

Dutt

et al. 2019

Monaldi Arch Chest Dis

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Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification

Mutignani

Dokas²,

Tringali

et al. 2017

Dig Dis Sci

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Endoscopic retrograde cholangiopancreatography in the treatment of pancreaticopleural fistula in children

Zhang

Gao

Guo

et al. 2020

WJG

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BACKGROUND Pancreaticopleural fistula (PPF) is a rare disease, especially in children. Conservative treatment and surgery are traditional therapies, but surgery is invasive. The emergence of endoscopic retrograde cholangiopancreatography (ERCP) has provided a new noninvasive treatment for PPF and may become the first choice for children with PPF. AIM To explore the treatment response to ERCP for PPF in children. METHODS Seven children with PPF were hospitalized in the Gastroenterology Department of Beijing Children’s Hospital from December 2007 to May 2019. Data on these seven patients’ clinical characteristics, diagnosis, treatments, and outcomes were analyzed, and their treatment responses following surgery and ERCP were compared. The correlation between the length of hospital stay and conservative treatment was analyzed. Peer-reviewed articles written in English and Chinese published from January 2009 to December 2019 were obtained from various open data sources and reviewed. RESULTS The seven patients comprised three boys and four girls with a mean age of 6.57 ± 3.26 years. The main symptoms were chest tightness and pain ( n = 4), intermittent fever ( n = 3), dyspnea ( n = 3), and abdominal pain ( n = 1), and all patients had bloody pleural effusion. All seven patients were diagnosed with PPF by magnetic resonance cholangiopancreatography, and all were initially treated conservatively for a mean of 34.67 ± 22.03 d with a poor response. Among five patients who underwent ERCP, one required surgery because of intubation failure; thus, the success rate of ERCP was 80%. Two patients were successfully treated with surgery (100%). The postoperative hospital stay of the two patients treated by surgery was 20 and 30 d, respectively (mean of 25 d), and that of the four patients treated by ERCP ranged from 12 to 30 d (mean of 19.25 ± 8.85 d). The recovery time after ERCP was short [time to oral feeding, 4-6 d (mean, 5.33 ± 1.15 d); duration of closed thoracic drainage, 2-22 d (mean, 13.3 d)]. Analysis of previous cases of PPF published worldwide during the past decade showed that the treatment success rate of ERCP is not lower than that of surgery. There was no significant difference in the postoperative hospital stay between surgery (16 ± 10.95 d) and ERCP (18.7 ± 6.88 d, P > 0.05). A positive linear correlation was found between the overall hospital stay and ERCP intervention time ( R 2 = 0.9992). CONCLUSION ERCP is recommended as the first-choice treatment for PPF in children. ERCP should be performed as early as possible if conditions permit.

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Resolution of pancreatico-pleural fistula with endoscopic ultrasound-guided therapy

Cited by 3 publications

References 15 publications

Pancreatic pleural effusion masquerading as right sided tubercular pleural effusion

Pancreatic pleural effusion masquerading as right sided tubercular pleural effusion

Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification

Endoscopic retrograde cholangiopancreatography in the treatment of pancreaticopleural fistula in children

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