Endoscopic management of pancreatic fistula after distal pancreatectomy and enucleation

BACKGROUND: Preoperative endoscopic pancreatic sphincterotomy (EPS) has been proposed to prevent postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) or enucleation (EN). The use of EPS as a curative treatment for POPF has been scarcely reported. We reported 10 consecutive patients who were successfully treated by EPS for a prolonged POPF. STUDY DESIGN: Ten patients underwent EPS for prolonged POPF (median duration = 40 days, range 20-114; median daily output = 80 mL, range 50-250) after 6 DPs, 2 ENs, and 2 medial pancreatectomies. RESULTS: EPS was performed in all patients, with stent insertion in 4. No patient developed a specific complication because of EPS. POPF healed within a median delay of 4 days (range 1-12). One patient underwent a repeated endoscopy to treat stent malposition. The median delay of discharge after EPS wits 13 days (range 8-15). With a 20-month median follow up, I patient developed early transient POPF recurrence because of spontaneous stent migration. CONCLUSIONS: EPS is indicated for prolonged POPF after DP or EN because it is highly feasible, shortens healing, and is well tolerated. (C) 2009 Elsevier Inc. All rights reserved.