Transpapillary stenting for pancreaticocutaneous fistulas

Kozarek, Richard A.; Ball, Terrance J.; Patterson, David J.; Raltz, Shirley L.; Traverso, L. William; Ryan, John A.; Thirlby, Richard C.

doi:10.1016/s1091-255x(97)80057-1

Cited by 61 publications

(32 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two studies reported that fistulae characterised by loss of continuity between the left and right sides of the main pancreatic duct (‘end fistulae’ or ‘disconnected duct syndrome’) or by downstream duct obstruction (from a stricture, stone or neoplasm) did not respond to conservative treatment and all required operative intervention [17, 49]. In contrast, the vast majority of fistulae characterised by maintained continuity with an unobstructed main pancreatic duct or gastrointestinal tract (‘side fistulae’), responded to conservative treatment [17, 50].…”

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

“…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%

“…Stents are retrieved 10–14 days after external fistula closure. Transpapillary stent placement is usually not possible when there is a fistula with discontinuity from the gastrointestinal tract and the remaining pancreatic duct (disconnected duct syndrome) [17, 49]. In a series from the University of Amsterdam, 15 patients with external pancreatic fistulae after necrosectomy underwent endoscopic retrograde pancreatography after a median of 35 days.…”

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

“…After a median time of 10 days drain production stopped in all 13 patients [56]. Complications of the endoscopic treatment included stent migration, stent occlusion and localised duct inflammation [49]. Other endoscopic techniques include selective cannulation and embolisation of the distal main pancreatic duct via the percutaneous route or the use of percutaneous catheter-directed drainage [58, 59].…”

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

See 3 more Smart Citations

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

102

View full text Add to dashboard Cite

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%.

show abstract

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

See 2 more Smart Citations

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

102

View full text Add to dashboard Cite

show abstract

“…Boerma et al [13] removed the stents after a median of 10 (range 2–64) days, obtaining fistula healing in 13 of 15 patients. Kozarek et al [16] reported 9 patients with pancreaticocutaneous fistulas, 8 of which closed successfully after pancreatic duct stenting, including 5 within 48 h. Stents were removed 10–14 days after fistula closure and no patient had recurrence at a median follow-up of 3 years [16]. Saeed et al [9] removed stents after 6 weeks, while still others have suggested 4–12 weeks before removal [17].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Transpapillary Stenting of Pancreatic Duct Disruption

Brennan

Stefaniak²,

Palmer³

et al. 2006

Dig Surg

View full text Add to dashboard Cite

Background/Aims: Endoscopic transpapillary stenting of the pancreatic duct is increasingly being used in the management of pancreatic duct disruption. In contrast to its more established role in pancreatic duct obstruction, little is reported on the spectrum of indications and outcome in management of pancreatic duct disruption. Methods: The indication for and outcome of transpapillary pancreatic duct stenting was analysed retrospectively in a UK supra-regional specialist pancreatobiliary centre, between January 1998 and August 2004. Results: Data were obtained on 30 patients (19 male, 11 female, median age 53 years). The main indications for pancreatic duct stenting were: pancreatic pseudocyst, pancreatic ascites, pancreatic duct leak following necrosectomy, and pancreaticopleural fistula. The median duration of stenting was 6 weeks for fistulae and 10 weeks for pseudocysts. Twenty-one patients (70%) had complete resolution. After a median follow-up of 45 months, no recurrence was noted in successfully treated patents. Conclusion: Endoscopic transpapillary pancreatic duct stenting is an increasingly valuable treatment option in the management of pancreatic fistulae and pseudocysts.

show abstract