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CC BY 4.0 · Journal of Digestive Endoscopy 2024; 15(01): 35-41
DOI: 10.1055/s-0044-1782227
Research Article

Natural History and Endoscopic Management of Pancreaticopleural Fistula: A Tertiary Care Center Experience

Pritam Das
1   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
,
Rakesh S. Kumar
1   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
,
Swapnil Mujawdiya
2   Department of Gastroenterology, RML Institute of Medical Sciences, Gomtinagar, Lucknow, Uttar Pradesh, India
,
Dhruv Thakur
1   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
,
Nagnath Wodeyar
1   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
,
Kartik Balankhe
1   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
,
Vivek Anand Saraswat
3   Department of Hepatology, MG Hospital, Sitapura, Jaipur, Rajasthan, India
,
Gaurav Pande
1   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
,
Samir Mohindra
1   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
› Author Affiliations Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University (Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow) The study was approved by the institutional committee and was conducted in accordance with the Declaration of Helsinki.
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Abstract

Background Pancreaticopleural fistula (PPF) is a rare complication associated with pancreatitis, caused by disruption of the pancreatic duct, either directly or through rupture of a peripancreatic fluid collection, resulting in leakage of pancreatic juice into the pleural space. It commonly presents as massive, relapsing pleural effusions, often on the left side with high amylase content. Nonspecific chest symptoms often predominate, making it a diagnostic challenge. There is a lack of clarity regarding the management of this rare entity.

Objectives This study aimed to review the typical presentations, pathophysiology, and current role of endoscopic therapy in patients with PPF.

Materials and Methods A retrospective analysis of the results of endoscopic treatment of patients with symptomatic PPF due to pancreatitis was done.

Results Ten patients with pancreatitis (6 males; mean age 33.6 ± 15.4 years: 6 chronic, 4 acute) with symptomatic PPF were analyzed. Endoscopic retrograde cholangiopancreatography was performed in all, with pancreatic sphincterotomy and stenting of the main pancreatic duct (passive transpapillary drainage). Technical and clinical success was achieved in 7/10(70%) and 10/10(100%) patients, respectively. Though the leak was bridged in three patients, pancreatic sphincterotomy and downstream stenting (when bridging was not possible) were successful in closing PPF. One (10%) patient needed surgery for gastric outlet obstruction. The mean duration of endotherapy was 12.1 ± 9.4 months and the time taken for leak closure was 15.3 ± 10.4 weeks. Long-term success of endoscopic treatment (median follow-up period of 48.9 ± 28.7 months) was achieved in all patients.

Conclusions Endoscopic treatment (passive trans-papillary drainage) is a safe and effective procedure for managing postinflammatory PPFs, and should be attempted in cases of failure of medical treatment.

Keywords

pancreaticopleural fistula - pancreatitis - pleural effusion - endoscopic retrograde cholangiopancreatography

Authors' Contributions

S.M. and V.A.S were involved in conceptualization, methodology, investigation, validation, resources, writing (original draft, review and editing), visualization, and supervision. P.D. and S.R.K. contributed to methodology, validation, writing (review and editing), and visualization. S.M. helped in methodology, investigation, data collection, validation, resources, and writing (original draft, review, and editing). D.T. and N.K. contributed to resources, visualization, and writing (reviewing and editing). K.B. helped in format analysis, reviewing, and editing. G.P. contributed to resources, visualization, and supervision.


Informed Consent

Informed consent was obtained from all individual participants included in the study.




Publication History

Article published online:
27 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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