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. 2018 Mar;32(3):1572-1580.
doi: 10.1007/s00464-018-6032-4. Epub 2018 Jan 17.

Endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticocolonic fistula

Mateusz Jagielski  1 , Marian Smoczyński  2 , Krystian Adrych  2
Affiliations

Endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticocolonic fistula

Mateusz Jagielski et al. Surg Endosc. 2018 Mar.

Abstract

Background: Pancreaticocolonic fistulas (PCFs) are serious complication of acute pancreatitis related with high mortality. The aim of this study was to evaluate the efficiency and safety of endoscopic treatment in patients with walled-off pancreatic necrosis (WOPN) complicated with PCF.

Methods: This is a retrospective analysis of results and complications in the group of 226 patients, who underwent endoscopic treatment of symptomatic WOPN between years 2001 and 2016 in the Department of Gastroenterology and Hepatology of Medical University of Gdańsk.

Results: PCF was recognized in 21/226 (9.29%) patients. Transmural drainage was performed in 20/21 (95.24%) patients. Transpapillary drainage was used in 2/21 (9.52) patients. The mean time since the start of endotherapy to the diagnosis of a fistulas was 9 (3-21) days. Fluoroscopic nasocystic tube-check imaging of an existing drain was the initial imaging diagnosis of a PCF in 19/21 (90.48%) patients. The mean duration of endoscopic drainage of WOPN was 39.29 (15-87) days. Procedure-related adverse events occurred in 10/21 (47.62%) patients and most of them were treated conservatively. Three patients required surgical treatment. One patient died during endotherapy. The closure of PCF was confirmed via imaging in 17/21 (80.95%) patients. The average time since the recognition till the closure of PCF was 21 (14-48) days. Complete therapeutic success of WOPN complicated with PCF was reached in 16/21 (76.19%) patients. Long-term success of endoscopic treatment was achieved in 15/21 (71.43%) patients.

Conclusions: Endoscopic treatment of patients with WOPN complicated with PCF is an effective method with an acceptable number of complications. The complete regression of the WOPN may lead to spontaneous closure of pancreaticocolonic fistulas.

Keywords: Acute pancreatitis; Endoscopic drainage; Endoscopic ultrasonography; Pancreatic fistula; Transmural drainage; Walled-off pancreatic necrosis.

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Conflict of interest statement

Mateusz Jagielski, Marian Smoczyński, and Krystian Adrych have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
A–C. Endoscopic transmural (transgastric) drainage of WOPN. The contrast applied through the nasal drain filled the necrotic collection, showing pancreaticocolonic fistula. (L left side of patient, R right side of patient)
Fig. 2
Fig. 2
A, B. Endoscopic retrograde pancreatography in the patient with WOPN. Applied contrast filled the main pancreatic duct with the visible complete duct disruption in the tail of pancreas. The contrast is leaking to the necrotic collection through the disruption. Pancreaticocolonic fistula with visible leakage to the lumen of colon is also well visible. (L left side of patient, R right side of patient)
Fig. 3
Fig. 3
A Abdominal contrast-enhanced computed tomography (CECT) done during the endoscopic treatment (video 1) showed a pancreaticocolonic fistula (red arrow) between the walled-off pancreatic necrosis cavity (blue stars) and the colon lumen (green arrow) in the area of splenic flexure. Nasal drain 7 French along with pancreatic endoprosthesis 7 French was inserted to the main pancreatic duct through the major duodenal papilla (active transpapillary drainage). (Color figure online)
See this image and copyright information in PMC

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