TY - JOUR
T1 - Endoscopic therapy for pancreatic fistulae
AU - Maniatis, A. G.
AU - Roman, R.
AU - Branch, M. S.
AU - Jowell, P. S.
AU - Affronti, J.
AU - Pappas, T.
AU - Baillie, J.
PY - 1996
Y1 - 1996
N2 - INTRODUCTION: Case reports and small series have indicated that endoscopic therapy for pancreatic fistulae (PF) may be successful. This series reviews the experience with PF at a tertiary care referral center. METHODS: A retrospective review of the DUMC endoscopic database between 09/30/87 and 09/30/95 identified 28 PF cases. Follow up was obtained for 25 patients ranging from 2 mths to 5 yrs (median 15 mths). RESULTS: Types of PF noted were pancreatoduodenal (PD)(11). pancreatoperitoneal (PT)(11), pancreatocutaneous (PC)(3), pancreatobiliary (PB)(2), and pancreatopleural (PP)(2). Patient characterisitics included: mean age 47.1 yrs, 61% male, 71% white, 25% African-American, and 4% Asian-American. Of the 66 ERCP performed (mean 2.4 ERCP/patient), 31 (47%) were therapeutic. Technical success was 98% for diagnostic and 94% for therapeutic ERCP PF etiology included: acute pancreatitis (9), chronic pancreatitis (8), pancreatic cancer (2), and iatrogenic (9) (7 post-pancreatic surgery, 1 post-operative biopsy, and 1 post-ERCP). Alcohol abuse was a major factor in 12 of 28 (43%) cases. Type and result of endoscopic therapy, as well as need for surgical therapy for each type of PF are noted below: PF Cases ERCP Type of Result of Adjunctive Surg. Type (#) (#) ERCP Rx*(#) ERCP Rx**/(#) Rx***#) Rx(#) PD 10 6 ST9, SP2, SEI C2, P 2, F 1. U1 0 3 PT 11 10 ST10, SP 1, NPD 1 C 5, P 2, F 2, X 1 10 4 PC 3 1 ST 3 C1 3 0 PB 2 1 ST 1 P 1 1 2 PP 2 1 ST 2 C 11*ST-stent, SP-sphincterotomy, SE-stone extraction, NPD=nasopancreatic drain.**C-complete success, P-partial success, F=faiture, U-unknown, X=insufncient trial***includes: TPN, distal enteric feeding, octreotide, percutaneous drainage Overall success rate for endoscopy therapy was 14/19 = 74% (47% complete, 26% partial). Ten of 28 cases (36%) ultimately required surgery (7 of 10 had prior endoscopic therapy). CONCLUSIONS: 1) In this series, 47% of PF were successfully managed with endoscopic ± adjunctive therapy. In an additional 26% of PF, a partial response to these therapies was noted 2) Adjunctive therapies are routinely used in all PF, save for PD, and may be integral to the success of nonsurgical management.
AB - INTRODUCTION: Case reports and small series have indicated that endoscopic therapy for pancreatic fistulae (PF) may be successful. This series reviews the experience with PF at a tertiary care referral center. METHODS: A retrospective review of the DUMC endoscopic database between 09/30/87 and 09/30/95 identified 28 PF cases. Follow up was obtained for 25 patients ranging from 2 mths to 5 yrs (median 15 mths). RESULTS: Types of PF noted were pancreatoduodenal (PD)(11). pancreatoperitoneal (PT)(11), pancreatocutaneous (PC)(3), pancreatobiliary (PB)(2), and pancreatopleural (PP)(2). Patient characterisitics included: mean age 47.1 yrs, 61% male, 71% white, 25% African-American, and 4% Asian-American. Of the 66 ERCP performed (mean 2.4 ERCP/patient), 31 (47%) were therapeutic. Technical success was 98% for diagnostic and 94% for therapeutic ERCP PF etiology included: acute pancreatitis (9), chronic pancreatitis (8), pancreatic cancer (2), and iatrogenic (9) (7 post-pancreatic surgery, 1 post-operative biopsy, and 1 post-ERCP). Alcohol abuse was a major factor in 12 of 28 (43%) cases. Type and result of endoscopic therapy, as well as need for surgical therapy for each type of PF are noted below: PF Cases ERCP Type of Result of Adjunctive Surg. Type (#) (#) ERCP Rx*(#) ERCP Rx**/(#) Rx***#) Rx(#) PD 10 6 ST9, SP2, SEI C2, P 2, F 1. U1 0 3 PT 11 10 ST10, SP 1, NPD 1 C 5, P 2, F 2, X 1 10 4 PC 3 1 ST 3 C1 3 0 PB 2 1 ST 1 P 1 1 2 PP 2 1 ST 2 C 11*ST-stent, SP-sphincterotomy, SE-stone extraction, NPD=nasopancreatic drain.**C-complete success, P-partial success, F=faiture, U-unknown, X=insufncient trial***includes: TPN, distal enteric feeding, octreotide, percutaneous drainage Overall success rate for endoscopy therapy was 14/19 = 74% (47% complete, 26% partial). Ten of 28 cases (36%) ultimately required surgery (7 of 10 had prior endoscopic therapy). CONCLUSIONS: 1) In this series, 47% of PF were successfully managed with endoscopic ± adjunctive therapy. In an additional 26% of PF, a partial response to these therapies was noted 2) Adjunctive therapies are routinely used in all PF, save for PD, and may be integral to the success of nonsurgical management.
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U2 - 10.1016/S0016-5107(96)80474-3
DO - 10.1016/S0016-5107(96)80474-3
M3 - Article
AN - SCOPUS:10544252459
SN - 0016-5107
VL - 43
SP - 410
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -