Adachi Akihisa, Yoshida Michihiro, Takada Hiroki, Hori Yasuki, Kato Akihisa, Sahashi Hidenori, Toyohara Tadashi, Kuno Kayoko, Kito Yusuke, Urakabe Kenji, Kataoka Hiromi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan.
Endoscopy Center, Kasugai Municipal Hospital, Kasugai, Japan.
Dig Dis Sci. 2025 May;70(5):1906-1914. doi: 10.1007/s10620-025-08945-9. Epub 2025 Feb 28.
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.
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.
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.
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.
非术后胰瘘通常由急性或慢性胰腺炎导致的胰管破裂引起。尽管内镜下经乳头引流和置入支架桥接以封堵破裂区域是传统的治疗方法，但其疗效仍不确定。本研究旨在评估经乳头引流治疗非术后胰瘘的疗效。
我们评估了2013年1月至2024年9月期间接受经乳头引流的22例患者的人口统计学特征、瘘管特征、支架桥接成功率以及成功的临床结局（定义为无症状、积液持续减少且无需额外引流）。
慢性胰腺炎（59%）和急性胰腺炎（27%）是主要病因。分别有9例（41%）和13例（59%）患者发生近端和远端胰管破裂。支架桥接成功率和临床成功率分别为55%和50%。瘘管部位、类型和支架桥接与临床成功显著相关（近端与远端：89%对23%，p = 0.01；完全破裂与其他类型：0%对65%，p = 0.04；成功与失败的支架桥接：82%对27%，p = 0.03）。成功的支架桥接显著取决于瘘管部位和类型（近端与远端：89%对31%，p = 0.01；完全破裂与其他类型：0%对71%，p = 0.01）。在技术上成功的支架桥接病例中，所有近端瘘管患者临床症状改善，而远端患者只有25%改善。
支架桥接主要在近端胰瘘中显示出疗效。然而，在涉及远端和完全胰管破裂的病例中，它面临挑战且疗效有限。
