Pancreatic-colonic fistula successfully treated with endoscopic transpapillary nasopancreatic drainage

Pancreatic pseudocyst with complicating colonic fistula successfully closed using the over-the-scope-clip system

“…time of writing, the patient has two internal drainage tubes in place and is under observation, but the pancreatic pseudocyst has decreased in size, and no signs of reinfection have been reported. Although there is no standard consensus regarding the treatment of pancreatic pseudocysts with a colonic fistula, some recent studies have reported successful closure of a fistula using only endoscopic drainage in order to avoid surgery [1,2]. In the present case, the cyst showed repeated infections after endoscopic drainage and it was determined that fistula closure would be necessary but would be difficult with endoscopic drainage alone; thus, the OTSC system was used.…”

Endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticocolonic fistula

“…Endoscopic drainage is also an alternative to other minimally invasive methods of treatment of pancreatic necrosis [ 13 , 14 ]. Several reports have described the efficiency of various minimally invasive techniques for the treatment of pancreatic fluid collections complicated with PCF [ 4 , 10 , 28 ]. Despite this, in the literature there are a few case reports available on the efficacy of endotherapy as the only method of minimally invasive treatment of patients with WOPN complicated with PCF [ 28 , 29 ].…”

Successful Conservative Management of Pancreatico-Colonic Fistula

“…Pancreatico-colonic fi stula may be objectifi ed by injection of contrast media into collection or pseudocyst during endoscopic or percutaneous drainage of them (cystography) [2,9]. ERCP is also useful to diagnosis but only if there is ductal disruption with communication between pancreatic necrosis or collection and main pancreatic duct [13]. On CT scan, an edematous and indistinct large bowel wall and the presence of air in the pancreatic bed is very suggestive for pancreaticocolonic fi stula [1].…”

“…Various endoscopic procedures were described. Drainage of pseudocyst either transmurally (endoscopic cystogastrostomy or cystoduodenostomy) or transpapillary (if there is connection with main pancreatic duct) permits rapid closure of the colonic fi stula, thus avoiding the need for surgical intervention [9,13,16]. Transpapillary stent insertion in the ductal disruption provides disconnection of pseudocyst [9].…”