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Surgical Endoscopy

Published in:

01-11-2015

Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors

Authors: Frédérique Maire, Philippe Ponsot, Clotilde Debove, Safi Dokmak, Philippe Ruszniewski, Alain Sauvanet

Published in: Surgical Endoscopy | Issue 11/2015

Abstract

Introduction

Pancreatic fistula (PF) are frequent after pancreatic surgical resection, and particularly after enucleation. Endoscopic treatment might be proposed for postoperative PF, but has never been evaluated after pancreatic enucleation.

Patients and methods

From January 2000 to June 2012, 161 patients underwent pancreatic enucleation in our center. In case of PF in the postoperative period, conservative management (somatostatin analogs combined with enteral or parenteral nutrition and drainage) was proposed. If PF persisted after 20 days (output >50 cc/d), endoscopic treatment (pancreatic sphincterotomy and stent placement if evidence of main duct leakage) was proposed. Primary outcome was the delay of PF closure after endoscopic treatment.

Results

Ninety-one patients (56 %) developed postoperative PF. PF closed within 3 weeks with conservative management in 78 (86 %) patients. Endoscopic treatment was required in 7 (8 %) patients. Daily PF output was 240 (50–300) mL. Pancreatic sphincterotomy was performed in all patients. A pancreatic stent was inserted in 4 of 5 patients with main pancreatic duct leakage. One patient presented a stent migration requiring a second procedure. No complication of endoscopic treatment was reported. The closure of PF was obtained in all cases, after 13 (3–24) days. Pancreatic stents were removed after 2, 5, 5, and 8 months, respectively. Median postoperative follow-up was 46 (21–70) months. At study endpoint, two patients had small asymptomatic pancreatic collections, four had mild dilatation of main pancreatic duct upstream pancreatic duct leakage, and none developed exocrine pancreatic insufficiency, diabetes, or recurrence of pancreatic tumor.

Conclusions

PF occurs in half patients after enucleation. Endoscopic treatment combining pancreatic sphincterotomy and stenting is safe and effective if conservative treatment fails, avoiding a complementary pancreatic resection.

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Title: Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors
Authors: Frédérique Maire
Philippe Ponsot
Clotilde Debove
Safi Dokmak
Philippe Ruszniewski
Alain Sauvanet
Publication date: 01-11-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-4034-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors

Abstract

Introduction

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusions

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