Practical Efficacy and Limitations of the Transpapillary Stent Bridging Technique for Non-postoperative Pancreatic Fistula.

BACKGROUND

Non-postoperative pancreatic fistula is usually caused by pancreatic duct disruption due to acute or chronic pancreatitis. Although endoscopic transpapillary drainage and stent bridging to block the disrupted area are traditional treatment approaches, their efficacy remains uncertain. This study aims to evaluate the efficacy of transpapillary drainage for non-postoperative pancreatic fistulas.

METHODS

We evaluated the demographic profiles, fistula characteristics, success rate of stent bridging, and successful clinical outcomes (defined as the absence of symptoms and a continuous reduction of fluid collection, and no need for additional drainage) of 22 patients who underwent transpapillary drainage from January 2013 to September 2024.

RESULTS

Chronic pancreatitis (59%) and acute pancreatitis (27%) were the main etiologies. Proximal and distal pancreatic duct disruptions occurred in nine (41%) and 13 (59%) patients, respectively. The success rate of stent bridging and clinical success rate were 55% and 50%, respectively. Fistula site, type, and stent bridging significantly correlated with clinical success (proximal vs distal: 89% vs. 23%, p = 0.01; complete disruption vs. other types: 0% vs 65%, p = 0.04; successful vs. failed stent bridging: 82% vs. 27%, p = 0.03). Successful stent bridging notably depended on fistula site and type (proximal vs. distal: 89% vs. 31%, p = 0.01; complete disruption vs. other types: 0% vs. 71%, p = 0.01). Among technically successful stent bridging cases, all proximal fistula patients improved clinically, whereas only 25% of distal patients did.

CONCLUSION

Stent bridging demonstrated efficacy primarily in proximal pancreatic fistulas. However, it posed challenges and showed limited efficacy in cases involving distal and complete pancreatic duct disruptions.