Endoscopic Transpapillary Stenting or Conservative Treatment for Pancreatic Fistulas in Necrotizing Pancreatitis Multicenter Series and Literature Review

Objective: Endoscopic transpapillary stenting (ETS) of the pancreatic duct facilitates ductal outflow and may reduce time to pancreatic fistula closure. However, data on the feasibility of ETS in patients with necrotizing pancreatitis are scarce. Background: Pancreatic fistulas often occur after intervention in necrotizing pancreatitis and frequently close only after months of conservative treatment. Methods: From a prospective cohort of patients with acute pancreatitis admitted in 15 hospitals (2004-2007), all patients who underwent ETS or conservative treatment for a pancreatic fistula were identified. Safety, feasibility, and outcome of ETS were evaluated. Furthermore, a literature review was performed for similar studies in necrotizing pancreatitis. Results: Of 731 patients with acute pancreatitis, 19 patients were treated with ETS and 16 patients were treated conservatively for a pancreatic fistula. Fistula closure was achieved in 16 of 19 patients (84%) in the ETS group and in 8 of 12 patients (75%) in the conservative group (P = 0.175). The median time to fistula closure after ETS was 71 days (interquartile range [IQR] 34-142) compared with 120 days (IQR 51-175 days) in the conservative group (P = 0.130). Complications were observed in 6 patients. A total of 10 studies reporting the results of 281 patients with stent placement for pancreatic fistulas were included in the literature review. Fistula closure was achieved in 200 patients (71%). Stent-related complications were reported in 9% of patients. Conclusions: ETS seems a feasible and safe alternative to conservative treatment in patients with pancreatic fistulas after intervention for necrotizing pancreatitis.