Novel treatment with double scope technique for disconnected pancreatic duct syndrome with external pancreatic fistula

Abstract

Background: External pancreatic fistula in association with disconnected pancreatic duct syndrome is a common sequelae of the percutaneous step-up approach for infected pancreatic necrosis and is associated with significant morbidity. The present study aims to report the initial outcome of a novel technique of two-scope guided tractogastrostomy for the management of this condition. Methods: The present study is a retrospective analysis of the data of the patients with external pancreatic fistula and disconnected pancreatic duct syndrome, who underwent two scope guided tractogastrostomy. All the patients had 24 Fr or larger drain placed in the left retroperitoneum. Transgastric echo endoscopy and sinus tract endoscopy were performed simultaneously to place a stent between the gastric lumen and the sinus tract. Technical success was defined as the placement of stent between the tract and the stomach. Clinical success was defined as the successful removal of the percutaneous drain without the occurrence of pancreatic fluid collection, ascites, external fistula, or another intervention after 12 weeks of the procedure Results: Three patients underwent two scope-guided tractogastrostomy. Technical and clinical success could be achieved in all the patients. No procedure-related side effects or recurrence occurred in any patient. Conclusion: Two-scope guided tractogastrostomy for treatment of external pancreatic fistula due to disconnected pancreatic duct syndrome is a feasible technique and can be further evaluated.