Percutaneous Transfistulous Interventions for Intractable Pancreatic Fistula

Abstract

Three techniques for the treatment of intractable pancreatic fistula: percutaneous transfistulous pancreatic duct drainage (PTPD), percutaneous transfistulous pancreatojejunostomy (PTPJ), and percutaneous transfistulous pancreatic duct embolization (PTPE) are presented as treatment options for intractable pancreatic fistula. PTPD is effective for most cases of intractable fistula that communicate with the main pancreatic duct. However, PTPD itself is not enough in some specific cases. PTPJ and PTPE are applicable in such cases.

A novel approach using liquid embolic agent for the treatment of pancreatic-cutaneous fistulas: Report of a case

“…Minimally invasive catheter drainage has been described as a choice of treatment for pancreatic duct leakage. 2,3 They, however, used a sclerosing agent, prolamine, as opposed to embolic glue. In the approach discussed in, 2 the sclerosant was delivered via the percutaneous drain that was positioned adjacent to the pancreas, not in the pancreatic duct as in our case.…”

“…For the patients with disconnected duct syndrome, they also use prolamine to sclerose the duct and their drainage catheter remains at the margin of the duct and does not cannulate the duct. 3 Pancreatic duct embolization has been previously reported including pancreatic duct remnant during pancreaticoduodenectomy 4 or as an alternative to complete pancreaticoduodenectomy in patients with chronic pancreatitis to block exocrine function. 5 Previous methods of duct embolization have used fibrin sealants; however, this process is not always successful and often necessitates repeat injections to seal the fistula.…”

Percutaneous direct pancreatic duct intervention in management of pancreatic fistulas: a primary treatment or temporizing therapy to prepare for elective surgery

“…For anastomotic fistulas after pancreato-duodenectomy an enteric access was necessary to enable trans-anastomotic cannulation. This approach was similar to what an endoscopically placed trans-anastomotic stent would achieve, and was created with direct puncture of the jejunal loop, or through a trans-hepatic tract if a direct enteric access was not feasible [3,4]. After the source of fistula was reached the duct was cannulated with angiographic catheters and guidewires.…”

“…While percutaneous drainage of PFC is widely utilized, a focal disruption of the duct can be an uncontrolled source of pancreatic secretions that can interfere with healing. Percutaneous interventions of the main pancreatic duct have been described but the experience reported is limited [2][3][4]. This study evaluates the feasibility, safety, and efficacy of percutaneous direct pancreatic duct interventions in the management of duct fistulas that were ineligible for, or had failed surgical and endoscopic management.…”

A comparative study on the complications of conventional and end-to-side inserting pancreatojejunostomy after pancreaticoduodenectomy

“…However, the morbidity rates remain high, ranging from 30 to 40 % [6][7][8]. Postoperative pancreatic fistula (POPF), which contributes to prolonged hospitalization and mortality, is the most common complication after PD [1,[9][10][11]. Thus, pancreatico-digestive anastomosis is important for ensuring the safety of PD.…”