Departments of Gastroenterology, and Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
Departments of Gastroenterology, and Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
Pancreatology. 2019 Jun;19(4):608-613. doi: 10.1016/j.pan.2019.05.454. Epub 2019 May 11.
External pancreatic fistulae (EPF) developing in setting of disconnected pancreatic duct syndrome (DPDS) are associated with significant morbidity and surgery is the only effective treatment.
To describe safety and efficacy of various endoscopic including endoscopic ultrasound (EUS) guided drainage techniques for resolving EPF in DPDS.
Retrospective analysis of data base of 18 patients (15 males; mean age: 37.6 ± 7.1years) with EPF and DPDS who were treated with various endoscopic techniques including EUS guided transmural drainage.
EPF developed post percutaneous drainage (PCD) (n = 15) or post-surgical necrosectomy (n = 3) of acute necrotic collections. All patients had refractory EPF with daily output of >50 ml/day with mean duration being 19.2 ± 6.1 weeks. One patient had failed surgical fistulo-jejunostomy. Various endoscopic techniques used were: transmural placement of pigtail stent through gastric opening of trans-gastric PCD (n = 5), EUS guided transmural puncture of fluid collection created by clamping PCD (n = 5) or by instillation of water though PCD (n = 3), direct EUS-guided puncture of fistula tract (n = 1) and EUS guided pancreaticogastrostomy (n = 4). EPF healed in 17/18 (94%) patients within 5-21 days and there has been no recurrence over follow up of 16.7 ± 12.8 weeks. Asymptomatic spontaneous external migration of stents was observed in 5/18 (29.4%) patients.
Management of refractory EPFs in setting of DPDS is challenging. In our experience, combination of various endoscopic techniques including EUS guided transmural drainage appears to be safe and effective treatment modality for treating these complex EPF's. However, further studies to identify patient selection and best treatment approaches are needed.
在断开的胰管综合征（DPDS）背景下发生的胰外瘘（EPF）与显著的发病率相关，手术是唯一有效的治疗方法。
描述各种内镜包括超声内镜（EUS）引导引流技术用于解决 DPDS 中 EPF 的安全性和有效性。
对 18 例 EPF 和 DPDS 患者的数据库进行回顾性分析，这些患者采用各种内镜技术进行治疗，包括 EUS 引导的经壁引流。
EPF 是在经皮引流（PCD）后（n=15）或急性坏死性脓肿的手术后（n=3）发展而来的。所有患者均有难治性 EPF，每天的引流量>50ml/天，平均持续时间为 19.2±6.1 周。1 例患者的手术瘘-空肠吻合术失败。使用的各种内镜技术包括：通过经胃 PCD 的胃开口放置猪尾支架（n=5）、EUS 引导经壁穿刺夹闭 PCD 时形成的积液（n=5）或通过 PCD 注水（n=3）、直接 EUS 引导穿刺瘘管（n=1）和 EUS 引导胰胃吻合术（n=4）。18 例患者中有 17 例（94%）在 5-21 天内 EPF 愈合，随访 16.7±12.8 周后无复发。在 18 例患者中有 5 例（29.4%）观察到支架无症状性自发外移。
DPDS 中难治性 EPF 的处理具有挑战性。根据我们的经验，包括 EUS 引导经壁引流在内的各种内镜技术的联合似乎是治疗这些复杂 EPF 的安全有效的治疗方法。然而，需要进一步的研究来确定患者的选择和最佳治疗方法。
