Abstract No. 326 - Fistulas from percutaneous drainage of pancreatic fluid collections: guidelines for systematic effective percutaneous management

Abstract

Purpose To evaluate a systematic approach for resolution of fistulas developing after percutaneous drainage of pancreatic fluid collections (PFCs). Materials and Methods IRB approved study that includes 52 patients. Patient inclusion criteria were patients that had symptomatic PFCs complicating pancreatitis evacuated by percutaneous drainage between 5/20/09 and 7/9/12. The pancreatitis causes were: alcoholic, 25 patients; gallstones, 11 patients; trauma, 10 patients; hyperlipidemia, 5 patients; unknown, 1 patient. Initial catheter drainage was followed by irrigation, sinograms and revisions. A fistula was defined as a communication between the residual PFC cavity with the pancreatic duct or digestive tract documented by catheter sinogram. Fistula management included dietary recommendations, reducing catheter number and size and octreotide administration. As the PFCs became smaller, catheters were reduced to one. The single drainage catheter was progressively downsized to an 8 FR latex catheter cannulating the fistula. Octreotide was given when a persistent fistula remained despite no residual infection or PFC cavity. Parameters measured were presence or absence of fistula, fistula type, fistula resolution and the need for surgery. Results Of 52 patients, 16 (31%) patients had a sinogram documented fistula: pancreaticocutaneous, 10 patients; duodenocutaneous, 2 patients; colocutaneous, 2 patients; combined pancreaticocutaneous and duodenocutaneous, 1 patient; gastrocutaneous, 1 patient. Pancreatic fistulas drained clear fluid while only one of the enteral fistula drained intestinal content through the catheter. All fistulas resolved. Mean duration of catheterization was 91 days (range 3 to 298 days). Octreotide cost limited its use to 2 patients that decreased drainage output and their fistula closed. Prolonged duration of catheterization and the need for catheter exchange were the only downsides of our strategy. One patient recurred and had an operation. There was no mortality. Conclusion In our series, the systematic percutaneous management approach presented was successful in resolving fistulas from PFCs drainage.