PANCREATIC LEAKS TREATED ACCORDING TO AN ENDOSCOPY-ORIENTED CLASSIFICATION: A TERTIARY-CARE CENTER EXPERIENCE

Aims In recent years, advances in interventional endoscopy have led to a substantial change in management algorithm of pancreatic leaks and fistula [2]. In 2017 our group proposed a new classification which combines anatomical and functional criteria with the purpose of guiding physicians in selecting the appropriate endoscopic treatment strategy for such conditions [3]. Aim of this study was to evaluate the validity and clinical usefulness of an endoscopy-oriented classification for pancreatic leaks in a clinical setting.

Methods All patients who underwent ERCP for pancreatic leaks between 1^st February 2012 and 31^th March 2019 were retrospectively reviewed. We gathered the following data: patients demographics, etiology of the leak, type of endoscopic treatment, success, number of procedures and adverse events

Results from 1^st February 2012 to 31^th March 2019, 67 patients who underwent endoscopic treatment for pancreatic leaks or fistula. In most cases pancreatic duct leaks occurred as a result of acute pancreatitis (n = 21), pancreatic or abdominal surgery (n = 41) or pancreatic trauma (n = 5). Pancreatic leaks were classified as type I (n = 10), type II (n = 27) and type III (n = 28) according to our endoscopy-oriented classification and treatment strategy were consistently selected. Overall technical success was 100% while clinical success was achieved in 89.2% of patients. At univariate analysis, only presence of sepsis and older age resulted associated with lower success. Clinical success required a mean of 1,9 procedures for patient (range 1 to 4 procedures).

Conclusions Our single-center experience shows excellent success rates achieved by tailoring treatment on the anatomic and functional features of the leak according to the above-mentioned classification. An endoscopy-oriented classification could lead to a better standardization of treatment, guide physician in the clinical setting and improve outcomes.