Su1463 Endoscopic Therapy With Transpapillary Stenting Is Effective in Patients With Grade B Pancreatic Distal Occlusion Failure After Distal Pancreatectomy or Splenectomy

Abstract

Endoscopic Therapy With Transpapillary Stenting Is Effective in Patients With Grade B Pancreatic Distal Occlusion Failure After Distal Pancreatectomy or Splenectomy Kavous Pakseresht, Savio Reddymasu, Brian Moloney, Daniel C. Buckles, Melissa M. Oropeza-Vail, Scott Stanley, Tuba Esfandyari, Scott Grisolano, Mojtaba S. Olyaee Kansas university Medical Center, Kansas city, KS Purpose: To study the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary pancreatic duct (PD) stent placement in a series of patients with grade B (International Study Group For Pancreatic Fistula classification) pancreatic distal occlusion failure (DOF) occurring as a complication of distal pancreatectomy (DP) or splenectomy. Methods: Eight (5 female) patients with a mean age of 55 years (range: 22-69) underwent endotherapy for grade B pancreatic DOF between January 1999 and May 2010. Base line demographics, duration between surgery and initial ERCP, pancreatogram findings, and details regarding endotherapy during the ERCP were reviewed. Results: The pancreatic DOF was a complication of DP in 6, DP with splenectomy in 1, and splenectomy alone in 1 patient. The mean amylase and lipase level in the peritoneal fluid at the time of initial ERCP was 15648 u/L and 2897 u/L respectively. The mean duration between surgery and the initial ERCP was 47 days (range: 13-85 days). The PD was cannulated and a transpapillary PD stent was deployed successfully in all patients. Seven patients (87%) had complete resolution of the pancreatic DOF after a mean number of 4 ERCP’s (range: 2-10). The mean duration between the initial PD stent placement and resolution of the pancreatic DOF was 121 days (range: 44-389 days). One patient was lost to follow-up. No serious complications were reported during ERCP. Conclusion: 1) A majority of grade B pancreatic DOF’s occurring as a complication of DP or splenectomy resolve after transpapillary PD stent placement. However, patients might require several endoscopic procedures prior to complete resolution of the pancreatic DOF. 2) ERCP with PD stent placement should be offered to patients with pancreatic DOF as a safe and effective alternative to surgery.