Fistulizing Pancreatic Duct Leakage in Patients with Chronic Pancreatitis: A Retrospective Case Series Emphasizing The Importance of a Multimodal Approach

Aims In patients with chronic pancreatitis, pancreatic duct leakage resulting in pancreatogenic pleural effusion and pancreatogenic ascites may be associated with prolonged disease course and serious complications. The primary endpoint was to assess the efficacy of multimodal treatment and further evaluate the safety of endoscopic treatment.

Methods In a retrospective design, consecutive patients with chronic pancreatitis with amylase content greater than 250 U/L in either ascites or pleural effusion treated from 2011 to 2020 were identified.

Results Twenty-two patients (18 males, median age 60, median ASA-score 3) were identified. Endoscopic retrograde pancreatography (ERP) with transpapillary stenting of the main pancreatic duct (MPD) was performed in 19 patients (86 %). Pancreatic sphincterotomy was performed in eight patients (42 %). Three patients (16 %) had extracorporeal shock wave lithotripsy (ESWL) due to stone in the MPD. Drainage of a peripancreatic fluid collection was done transgastric (n = 3)(16 %), percutaneous (n = 4)(21 %), and in a combination (n = 2)(11 %). One patient (5 %) was referred for a distal pancreatectomy. Eight patients (42 %) were treated with somatostatin analogues, parenteral nutrition, and “nill per mouth” for a median period of 7 days (range 4-15).The remaining three out of 22 patients (14 %) were treated without ERP in a combination of ESWL (n = 2), PCD of a PPFC (n = 1) and endoscopic drainage of a PPFC (n = 1).Tweenty-two patients (100 %) had resolution of both ascites and pleural effusion. Seventeen patients (77 %) were without stent after a median of five endoscopic procedures (range 2-10) performed during a median of 10 months (range 1-55). None of the 17 patients had re-interventions during a further median 34 months (range 3-99). Five patients (23 %) had a stent in DP after a median of two endoscopic procedures (range 1-10) during a median of 12 months (range 1-14).

Tab. 1

Adverse event (n = 5) 26 %

Post-ERCP AP (n = 2)

Perforation of duodenal bulb (n = 2)

Retained fragment (n = 1)

Conclusions Multimodal treatment of fistulizing pancreatic duct leakage is succesfull with a minimal need of surgical interventions.

Citation: Roug S, Novovic S, Feldager E et al. OP172 FISTULIZING PANCREATIC DUCT LEAKAGE IN PATIENTS WITH CHRONIC PANCREATITIS: A RETROSPECTIVE CASE SERIES EMPHASIZING THE IMPORTANCE OF A MULTIMODAL APPROACH. Endoscopy 2021; 53: S70.

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Artikel online veröffentlicht:
19. März 2021