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. 2025 May;70(5):1906-1914.
doi: 10.1007/s10620-025-08945-9. Epub 2025 Feb 28.

Practical Efficacy and Limitations of the Transpapillary Stent Bridging Technique for Non-postoperative Pancreatic Fistula

Akihisa Adachi  1 , Michihiro Yoshida  2 , Hiroki Takada  3 , Yasuki Hori  1 , Akihisa Kato  1 , Hidenori Sahashi  1 , Tadashi Toyohara  1 , Kayoko Kuno  1 , Yusuke Kito  1 , Kenji Urakabe  1 , Hiromi Kataoka  1
Affiliations

Practical Efficacy and Limitations of the Transpapillary Stent Bridging Technique for Non-postoperative Pancreatic Fistula

Akihisa Adachi et al. Dig Dis Sci. 2025 May.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Disconnected pancreatic duct syndrome; Pancreatic fistula; Stent bridging; Transpapillary drainage.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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