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Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification

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Abstract

Background

Pancreatic leaks occur as a complication of upper gastrointestinal surgery, acute pancreatitis, or abdominal trauma. Pancreatic fistulas and leaks are primarily managed conservatively. Overall, conservative measures are successful in more than half of cases. Whenever conservative treatment is not efficient, surgery is usually considered the treatment of choice. Nowadays however, endoscopic treatment is being increasingly considered and employed in many cases, as a surgery sparing intervention.

Aim

To introduce a classification of pancreatic fistulas according to the location of the leak and ductal anatomy and finally propose the best suited endoscopic method to treat the leak according to current literature.

Methods

We performed an extensive review of the literature on pancreatic fistulae and leaks.

Results

In this paper, we review the various types of leaks and propose a novel endoscopic classification of pancreatic fistulas in order to standardize and improve endoscopic treatment.

Conclusions

A proper and precise diagnosis should be made before embarking on endoscopic treatment for pancreatic leaks in order to obtain prime therapeutic results. A multidisciplinary team of interventional endoscopists, pancreatic surgeons, and interventional radiologists is best suited to care for these patients.

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Author information

Authors and Affiliations

  1. Digestive and Interventional Endoscopy Unit, Ospedale Ca’Granda Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162, Milan, Italy

    Massimiliano Mutignani, Alberto Tringali, Edoardo Forti, Francesco Pugliese, Marcello Cintolo & Lorenzo Dioscoridi

  2. Endoscopy Department, St Lukes Private Hospital, 55236, Panorama, Thessaloníki, Greece

    Stefanos Dokas

  3. Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino Estense di Baggiovara, Via Pietro Giardini, 1355, 41126, Baggiovara, MO, Italy

    Raffaele Manta

Authors
  1. Massimiliano Mutignani
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  2. Stefanos Dokas
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  3. Alberto Tringali
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Correspondence to Stefanos Dokas.

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Mutignani, M., Dokas, S., Tringali, A. et al. Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification. Dig Dis Sci 62, 2648–2657 (2017). https://doi.org/10.1007/s10620-017-4697-5

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  • DOI: https://doi.org/10.1007/s10620-017-4697-5

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