Endoscopic treatment of external pancreatic fistulas:: When draining the main pancreatic duct is not enough
Endoscopic treatment of external pancreatic fistulas:: When draining the main pancreatic duct is not enough
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DOI：
10.1111/j.1572-0241.2006.01014.x
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发表时间：
2007-03-01
影响因子：
9.8
通讯作者：
Deviere, Jacques
中科院分区：
文献类型：
--
作者：
Arvanitakis, Marianna;Delhaye, Myriam;Deviere, Jacques
目的：主胰管（MPD）经乳头引流已被提议用于治疗胰外瘘（EPF），但可能不足以治疗复杂病例。本研究的目的是探讨各种内镜下或经皮和内镜技术相结合的治疗EPFs.METHODS：16例EPFs患者在我们的部门进行了治疗。应用的技术和患者的临床outcomes.RESULTS：所有患者，但三个接受经乳头MPD引流胰腺括约肌切开术（N = 13）。进行的其他内镜手术包括：（a）胰液收集（PFC）引流（N = 5），（B）瘘道和胃肠道（GI）之间的透壁引流（N = 5），和（c）由于胰管完全破裂（N = 1）进行内镜超声（EUS）引导的胰十二指肠吻合术。除1例需要手术外，所有患者均实现了瘘管闭合。在18个月（范围6-52）的中位随访期内，3例患者瘘管复发，2例患者PFC复发。两种情况都通过反复内镜治疗成功治愈。所有复发发生在3个月内的初步成功treatment.CONCLUSIONS：联合内镜和经皮治疗似乎是安全和有效的复杂情况下EPFs的管理。
OBJECTIVES: Transpapillary drainage of the main pancreatic duct (MPD) has been proposed for the treatment of external pancreatic fistulas (EPF) but may not suffice to treat complex cases. The aim of the present study was to explore the efficacy of various endoscopic or combined percutaneous and endoscopic techniques in the treatment of EPFs.METHODS: Sixteen patients presenting with EPFs were treated in our department. The techniques applied and patients' clinical outcome are described.RESULTS: All but three patients underwent transpapillary MPD drainage by pancreatic sphincterotomy (N = 13). Additional endoscopic procedures performed were: (a) pancreatic fluid collection (PFC) drainage (N = 5), (b) transmural drainage between the fistula path and the gastrointestinal (GI) tract (N = 5), and (c) endoscopic ultrasound (EUS)-guided pancreaticoduodenostomy because of complete pancreatic duct rupture (N = 1). Fistula closure was achieved in all patients except one, who required surgery. During a median follow-up period of 18 months (range 6-52) three patients had fistula recurrence, and two, PFC recurrence. Both conditions were cured successfully by repeated endoscopic therapy. All recurrences occurred within 3 months of initial successful treatment.CONCLUSIONS: Combined endoscopic and percutaneous treatment appears to be safe and effective for the management of complex cases of EPFs.