Endoscopic management of pancreatic fistula after distal pancreatectomy and enucleation

BackgroundPreoperative 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 designTen 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.ResultsEPS 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 was 13 days (range 8–15). With a 20-month median follow up, 1 patient developed early transient POPF recurrence because of spontaneous stent migration.ConclusionsEPS is indicated for prolonged POPF after DP or EN because it is highly feasible, shortens healing, and is well tolerated.