Treatment Of Pancreatic Fistula Research Articles

The endoscopic management of pancreatic fistulas

Interest in the use of therapeutic endoscopy for the treatment of pancreatic diseases has been on the increase for several years. Our aim was to assess the efficacy of endoscopic retrograde cholangiopancreaticography (ERCP) in the treatment of pancreatic fistulas. We evaluated the results of therapeutic ERCP in 50 patients with pancreatic fistula treated at the Helsinki University Central Hospital from 1998 to 2003. The success rate of fistula closure after therapeutic ERCP was 82%. Five patients required operative treatment when ERCP was unsuccessful. There was little morbidity and no procedure-related mortality. Four patients died because severe illnesses made them unfit for any further procedures. ERCP is a safe and effective modality and should be considered as first-line therapy in the management of pancreatic fistula.

Endoscopic pancreatic stent insertion for treatment of pseudocyst after distal pancreatectomy

Pancreatic fistula and pseudocyst are common complications of pancreatic resection. 1 Ridgeway MG Stabile B. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996; 76: 1159-1173 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 2 Bassi C Falconi M Pederzoli P Pancreatic fistula. in: 3rd ed. Surgical diseases of the pancreas. : Williams & Wilkins, Baltimore1998: 827-834 Google Scholar Such complications prolong hospitalization and may lead to abscess formation, sepsis, and hemorrhage. 1 Ridgeway MG Stabile B. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996; 76: 1159-1173 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 2 Bassi C Falconi M Pederzoli P Pancreatic fistula. in: 3rd ed. Surgical diseases of the pancreas. : Williams & Wilkins, Baltimore1998: 827-834 Google Scholar Most fistulas and pseudocysts resolve spontaneously, albeit over lengthy periods, with conservative treatment including pancreatic rest (no oral intake with total parenteral nutrition or octreotide administration) and adequate drainage (drains placed during the initial operation or postoperatively via the percutaneous approach). 1 Ridgeway MG Stabile B. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996; 76: 1159-1173 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 2 Bassi C Falconi M Pederzoli P Pancreatic fistula. in: 3rd ed. Surgical diseases of the pancreas. : Williams & Wilkins, Baltimore1998: 827-834 Google Scholar , 3 Pederzoli P Bassi C Falconi M Albrigo R Vantini I Micciolo R. Conservative treatment of external pancreatic fistulas with parenteral nutrition alone or in combination with continuous intravenous infusion of somatostatin, glucagon or calcitonin. Surg Gynecol Obstet. 1986; 163: 428-432 PubMed Google Scholar , 4 Prinz RA Pickleman J Hoffman JP. Treatment of pancreatic cutaneous fistulas with a somatostatin analog. Am J Surg. 1988; 155: 36-42 Abstract Full Text PDF PubMed Scopus (139) Google Scholar For pancreatic fistulas and pseudocysts refractory to conservative treatment, surgical intervention is indicated but is often technically difficult and associated with a high morbidity rate (13%). 5 Lipsett PA Cameron JL. Internal pancreatic fistula. Am J Surg. 1992; 163: 216-220 Abstract Full Text PDF PubMed Scopus (121) Google Scholar Only a few reports have described endoscopic pancreatic stent placement for treatment of pancreatic duct leakage after pancreatic resection. 6 Saeed ZA Ramirez FC Hepps KS. Endoscopic stent placement for internal and external pancreatic fistulas. Gastroenterology. 1993; 105: 1213-1217 PubMed Google Scholar , 7 Sarzen CD. Endoscopic management of pancreatic duct leak complicated by retrogastric abscess. Am J Gastroenterol. 1995; 90: 2039-2041 PubMed Google Scholar Herein is described a case in which endoscopic transpapillary placement of a pancreatic stent was effective treatment for a pancreatic pseudocyst that developed after distal pancreatectomy.

Endoscopic treatment of pancreatic fistulas and abscesses

Endoscopic treatment of pancreatic fistulas and abscesses

Octreotide administration in the treatment of pancreatic fistulae after pancreas transplantation.

Among the surgical complications of pancreas transplantation are pancreatic fistulae, which arise rather frequently. Suppression of exocrine secretion with polymers has succeeded in reducing the rate of this complication. Nevertheless, in some instances, pancreatic fistulas may occur. Thirty pancreas transplantations were performed in 27 diabetic patients. In 5 cases a pancreatic fistula occurred and was drained after the insertion of a catheter for the collection of secretions. A serous liquid was collected with a high concentration of amylases (61604 +/- 19562 IU/24 h). Fistula output was 280 +/- 87 ml/24 h. Patients were treated with octreotide, administered subcutaneously in a dose of 300-750 micrograms/day. In all patients a progressive reduction in fistula output was observed after a mean of 16 + 2 days. Fistula flow rate dropped to 24 +/- 10 ml/24 h--a reduction of 95% +/- 5% and drainage was subsequently stopped. Sonographic follow-up did not show recurrence of peripancreatic collections in these patients. All patients were insulin-independent up to 12-44 months after surgery.

Octreotide administration in the treatment of pancreatic fistulae after pancreas transplantation

Octreotide administration in the treatment of pancreatic fistulae after pancreas transplantation

Acute haemorrhagic pancreatico-pleural effusion treatedwith somatostatin analogue SMS 201-995

Pancreatic exocrine secretion can be inhibited by the naturally occurring hormone somatostatin (1). Although effective in the treatment of pancreatic fistula, the clinical application of somatostatin has been limited by its short half-life (2). The new long-acting somatostatin analogue, SMS 210-995 (Sandostatin) which is resistant to enzymic degradation (3) has been effective in ablating pancreatico-cutaneous fistulae (4-7). We describe a case of chronic pancreatitis associated with haemorrhagic pancreatico-pleural effusion which resolved following treatment with SMS 201-995.

Treatment of Pancreatic Fistulas with Somatostatin and Total Parenteral Nutrition

Nineteen pancreatic fistulas were treated with somatostatin (ST) and total parenteral nutrition (TPN). Five of the fistulas developed in an uninflamed pancreas, whereas 14 fistulas developed secondary to a necrotizing or chronic pancreatitis. Fistular output varied between 20 and 800 ml/day (median, 160 ml) during TPN before ST treatment; amylase concentration was 10,500-800,000 UI/l. Twelve of 16 (75%) fistulas were contaminated with bacteria. Thirteen of 19 (68%) fistulas closed after a median treatment of 7 (range, 2-14) days. Seven of eight fistulas with open drainage to the bowel healed, whereas only one of six with obstructed drainage closed. All of the uninfected fistulas and half of the infected fistulas closed. The findings suggest that somatostatin treatment speeds up the closure of pancreatic fistulas with open drainage to the bowel but is not beneficial when the intestinal drainage of the fistular region to the bowel is obstructed.

THE TREATMENT OF PANCREATIC FISTULA FOLLOWING RUPTURE OF PANCREAS: REPORT OF A CASE

The statement is made by Stern 1 that traumatic pancreatitis, in which the pancreas is the only organ originally injured, is an exceedingly rare condition. The full and comprehensive review of the literature, as given by that author, is ample support to that statement. Whenever pancreatic fistula has developed following injury, the management of these cases has been perplexing and the mortality always high. The management of one of these rare and interesting cases, wherein the pancreas was the only organ injured and in which healing was complete three weeks after the appearance of the fistula, is herewith described. The treatment used in this case was first suggested by Potter 2 for duodenal fistula. I have been unable to find that this treatment has been used in the treatment of pancreatic fistula, prior to its use in the case reported here. Potter 3 states that he has no knowledge of