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Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors

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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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Abbreviations

PF:

Pancreatic fistula

ERP:

Endoscopic retrograde pancreatography

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Disclosures

Drs. Frédérique Maire, Philippe Ponsot, Clotilde Debove, Safi Dokmak, Philippe Ruszniewski and Alain Sauvanet have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy Cedex, France

    Frédérique Maire, Philippe Ponsot & Philippe Ruszniewski

  2. Service de Chirurgie Viscérale, Hôpital Beaujon, AP-HP, Clichy Cedex, France

    Clotilde Debove, Safi Dokmak & Alain Sauvanet

  3. Paris-Diderot University, Paris, France

    Clotilde Debove, Safi Dokmak & Alain Sauvanet

Authors
  1. Frédérique Maire
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  2. Philippe Ponsot
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  3. Clotilde Debove
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  4. Safi Dokmak
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  5. Philippe Ruszniewski
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  6. Alain Sauvanet
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Correspondence to Frédérique Maire.

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Maire, F., Ponsot, P., Debove, C. et al. Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors. Surg Endosc 29, 3112–3116 (2015). https://doi.org/10.1007/s00464-014-4034-4

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  • DOI: https://doi.org/10.1007/s00464-014-4034-4

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