External Pancreatic Fistulas Resistant to Conventional Endoscopic Therapy: Endoscopic Closure With N-Butyl-2-Cyanoacrylate (Glubran 2)

External pancreatic fistulas may follow abdominal surgery or injury. While most respond to conservative management or endoscopic intervention, others might require surgery for complete healing. We report four cases of patients with external pancreatic fistulas that failed to respond to conservative management and drainage. N-butyl-2-cyanoacrylate surgical glue (Glubran 2) was directly injected into the fistulous tract. The fistulas closed within 24 hours of the Glubran 2 injection in three cases (75 %). In patients with external pancreatic fistulas that fail to respond to conservative and endoscopic drainage, injection of Glubran 2 directly into the fistulous tract may lead to closure, thus avoiding the need for surgical intervention.

References

• 1 Kozarek R A, Traverso L W. Pancreatic fistulas: etiology, consequences and treatment.  Gastroenterologist. 1996;  4 238-244
• 2 Ridgeway M G, Stabile B E. Surgical management and treatment of pancreatic fistulas.  Surg Clin N Am. 1996;  76 1159-1173
• 3 Bassi C, Falconi M, Salvia R. et al . Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience.  Langenbecks Arch Surg. 2000;  385 10-13
• 4 Martineau P, Shwed J A, Denis R. Is octreotide a new hope for enterocutaneous and external pancreatic fistulas closure?.  Am J Surg. 1996;  172 386-395
• 5 Gullo L, Biliotti G, Pezzilli R. et al . Effect of octreotide (SMS 201-995) on meal-stimulated pancreatic secretion in three patients with external pancreatic fistula.  Am J Gastroenterol. 1991;  86 892-894
• 6 Costamagna G, Mutignani M, Ingrosso M. et al . Endoscopic treatment of postsurgical external pancreatic fistula.  Endoscopy. 2001;  33 317-322
• 7 Quinn J, Wells G, Sutcliffe T. et al . A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations.  JAMA. 1997;  277 1527-1530
• 8 N-BCA T rail. N-butyl cyanoacrylate embolization of cerebral arteriovenous malformations: results of a prospective, randomized multi-center trial.  Am J Neuroradiol. 2002;  23 748-755
• 9 Dhiman R K, Chawla Y, Taneja S. et al . Endoscopic sclerotherapy of gastric variceal bleeding with n-butyl-2-cyanoacrylate.  J Clin Gastroenterol. 2002;  35 222-227
• 10 Seewald S, Groth S, Sriram P VJ. et al . Endoscopic treatment of biliary leakage with n-butyl-2 cyanoacrylate.  Gastrointest Endosc. 2002;  56 916-919
• 11 Vinters H V, Galil K A, Lundie M J. et al . The histotoxicity of cyanoacrylates. A selective review.  Neuroradiology. 1985;  27 279-291
• 12 Montanaro L, Arciola C R, Cenni E. et al . Cytotoxicity, blood compatibility and antimicrobial activity of two cyanoacrylate glues for surgical use.  Biomaterials. 2001;  22 59-66
• 13 Levrier O, Mekkaoui C, Rolland P H. et al . Efficacy and low vascular toxicity of embolization with radical versus anionic polymerization of n-butyl-2-cyanoacrylate (NBCA). An experimental study in the swine.  J Neuroradiol. 2003;  30 95-102
• 14 Becker R J, Bass R T, Zajtchuk R. et al . External pancreatic fistula following abdominal injury.  Arch Surg. 1967;  95 556-566
• 15 Bassi C, Butturini G, Salvia R. et al . A single-institution experience with fistulojejunostomy for external pancreatic fistulas.  Am J Surg. 2000;  179 203-206
• 16 Boerma D, Rauws E A, van Gulik T M. et al . Endoscopic stent placement for pancreaticocutaneous fistula after surgical drainage of the pancreas.  Br J Surg. 2000;  87 1506-1509
• 17 Ihse I, Larsson J, Lindstrom E. Surgical management of pure pancreatic fistulas.  Hepatogastroenterology. 1994;  41 271-275
• 18 Howard T J, Ock C E, Sarkar J. et al . Contemporary treatment strategies for external pancreatic fistulas.  Surgery. 1998;  124 627-632