Pancreatic stent placement is associated with resolution of refractory grade C pancreatic fistula after left-sided pancreatectomy

Abstract

Pancreatic fistula have been a source of significant morbidity and mortality after left-sided pancreatectomy. The majority of fistulas are classified as Grade A and resolve quickly with no intervention. Grade C pancreatic fistulas, which require percutaneous or operative drainage, are less common and may be associated with morbidity and mortality. We used postoperative endoscopic pancreatic stent placement as an adjunctive strategy in the management of refractory Grade C pancreatic fistulas. Patients undergoing endoscopic pancreatic stent placement for persistent, refractory peripancreatic fluid collections/pancreatic fistula after left-sided pancreatectomy were identified. Eight patients underwent endoscopic pancreatic stent placement for refractory Grade C pancreatic fistulas. Six patients had percutaneous catheter placement; two patients had transgastric drainage. Endoscopic retrograde cholangiopancreatography (ERCP) showed extravasation of contrast from the distal end of the pancreatic duct in seven patients. Pancreatic stents were placed in all patients at a median time of 48 days postoperation and left for a median of 47 days. Before stent removal, ERCP demonstrated pancreatic fistula closure. Median time to complete resolution of the fistula was 41 days after stent placement. Endoscopic pancreatic stents were associated with resolution of Grade C fistulas. After distal pancreatectomy, pancreatic stent placement should be considered in the postoperative period for refractory pancreatic fistulas.

Fig. 1

Technique of postoperative pancreatic stenting and results. (A) CT scan of patient on postoperative Day 12 demonstrating postoperative pancreatic fistula (POPF) at the site of pancreas transection not accessible to percutaneous drainage. (B–C) ERCP demonstrating extravasation of contrast and pancreatic duct stenting on postoperative Day 14. (D) CT scan of the abdomen and pelvis on postoperative Day 21 demonstrating resolution of the POPF.