Endoscopic management of pancreatic ascites due to duct disruption following acute necrotizing pancreatitis

Background and Aim: Acute necrotizing pancreatitis (ANP) can be associated with pancreatic duct (PD) disruption. PD disruption can lead to the formation of internal fistulae and consequent pancreatic ascites. Pancreatic ascites is reported very rarely following ANP, and therefore, the role of endotherapy in this setting is not defined. To retrospectively study the safety and efficacy of endoscopic drainage in patients with pancreatic ascites following ANP. Methods: Over a period of 6 years, 12 patients (10 males; mean age: 35.9 +/- 7.1 years) with pancreatic ascites following ANP underwent an attempted endoscopic drainage. Patients with a coexistent pancreatic fluid collection (PFC) underwent endoscopic ultrasound (EUS)-guided transmural drainage of PFC whereas patients with pancreatic ascites alone underwent transpapillary drainage alone. Results: Nine (75%) patients had coexistent PFC, whereas three patients presented with ascites only. The mean size of PFC was 7.2 perpendicular to 1.6 cm. Patients with PFC underwent successful EUS-guided transmural drainage (multiple plastic stents in eight and metal stent in one patient) with complete resolution of PFC as well as ascites within 2-3weeks. Of three patients with ascites alone, one patient had complete PD disruption, whereas two patients had partial PD disruption. Both patients with partial disruption underwent successful placement of bridging transpapillary stent and resolution of ascites at 6weeks. In patients with complete disruption, a nonbridging stent was placed into the disruption, and ascites resolved after 8weeks. There has been no recurrence over 27.5 +/- 17.7 weeks. Conclusion: Endoscopic drainage is a safe and effective treatment modality for the treatment of pancreatic ascites following ANP.