Successful Internal Drainage of Pancreatic Fistulas following Pancreatic Resections Using ERCP

Kristina Spate, MD, Hannah Palin, Michael Egger, MD, Gary C Vitale, MD

Department of Surgery, University of Louisville

Introduction: To describe the results using Endoscopic Retrograde Cholangiopancreatography (ERCP) in the management of postoperative pancreatic fistulas as a method of internal drainage

Methods: A retrospective chart review was performed on all patients who underwent ERCP as a therapeutic modality for postoperative pancreatic fistulas during the years 2000-2012. Patients who had pancreatic fistulas following pancreatic debridements for necrotizing pancreatitis were excluded from this study. The data was analyzed with regard to demographics, diagnosis, types of operations, average number of ERCPs, average drain amylase levels, average time stent was in place, fistula recurrence, successful removal of external drain, morbidity and mortality.

Results: During the study period a total of 12 patients with postoperative pancreatic fistulas were treated with ERCP. There were 9 males and 3 females with a mean age of 58 (range=34-82). The diagnoses at the time of operations were: benign cystic neoplasms (n=3), chronic pancreatitis (n=4), pancreatic adenocarcinoma (n=3), adrenal mass (n=1) and neuroendocrine tumor (n=1). The operations performed were 5 subtotal pancreatectomies, 5 distal pancreatectomies, 1 tumor enucleation and 1 adrenalectomy. The mean drain amylase level was 10,324 (range 11-56,669). One ERCP attempt was unsuccessful secondary to a pancreatic ductal stricture for a successful cannulation rate of 92%. The average number of ERCPs performed per patient was 2.5 (range 1-4). The average time the stent was in place was 2.4 months (range 1-4 months). There were no complications associated with performing the ERCP and all 11 patients had their external drain removed during the time the stent was in place. One mortality occurred during this study period from overt sepsis for a mortality rate of 8%.

Conclusion: ERCP is a safe and effective method for internal drainage and treatment of postoperative pancreatic fistulas and can be a reasonable alternative after failure of conservative management.

Session: Poster Presentation

Program Number: P353

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