The value of the endoscopic pancreatogram in peritoneal or pleural pancreatic fistula.

Endoscopic retrograde pancreatogram (ERP) has been recommended in patients with suspected pancreatic fistula to visualize the fistula tract and the ductal anatomy. Recently we have treated five men with chronic alcoholic pancreatitis complicated by pancreaticopleural or pancreaticoperitoneal fistula. The limited value of ERP in these patients is described. Computed tomography (CT) demonstrated dilated pancreatic duct (3 patients) or a pseudocyst (2 patients). A fistula tract protruding into the chest was detected by CT in two patients. In ERP the two pseudocysts could not be visualized. In none of the five patients could the fistula tract be visualized. Instead, the main pancreatic duct was completely occluded in the head of the pancreas in all five patients. The drainage of the pancreatic juice into the intestine was secured surgically by a jejunal Roux-Y loop connected to the pancreatic duct opened from the tail to the most proximal ERP demonstrated stricture (Puestow-type operation, 4 patients) or to the leaking pseudocyst (1 patient). During the follow-up of 3-24 months pleural or peritoneal effusions have not recurred. The role of ERP in a patient with a pancreatic fistula into the pleural or peritoneal cavity is to localize the site of the duct obstruction, whereas the demonstration of the distal duct anatomy or the fistula tract are of less importance.