ENDOSCOPIC MANAGEMENT OF POSTOPERATIVE PANCREATIC FISTULAS (POPF) ARISING AFTER DISTAL PANCREATECTOMY OR ENUCLEATION: A TERTIARY CARE CENTER EXPERIENCE

Aims Only small series have described the endoscopic management of POPF. The purpose of this retrospective study was to describe the indications, technique and results of endoscopic treatment of POPF in our experience.

Methods consecutive patients with POPF receiving endoscopic retrograde cholangiopancreatography (ERCP)-based treatment between January 2010 and November 2018 were identified from a prospectively maintained database. POPF was classified according to the International Study Group of Pancreatic Fistula. The indications, the techniques and results of endoscopic drainage and the patients´ outcomes were registered.

Results Among 9343 ERCPs performed during the inclusion period, 41 patients had POPF treated endoscopically (23 women, 18 men, mean age ±standard deviation [SD]: 65 years [±14]). Surgeries at the origin of the fistula were: distal pancreatectomy with spleen resection (n=26); spleen-preserving distal pancreatectomy (n=5); central pancreatectomy (n=3); enucleation (n=5); partial pancreatectomy (n=1); left nephrectomy (n=2), for the following indications: IPMN (n=8), pancreatic adenocarcinoma (n=7), neuroendocrine tumors (n=4), insulinoma (n=6), adrenocortical carcinoma (n=6), pancreatic metastasis (n=2), pheochromocytoma (n=1), cystadenoma (n=2), spleen artery aneurysm (n=1), serous cystadenoma (n=1), chronic pancreatitis (n=2), lymphoepithelial cyst (n=1). The median time between surgery and first ERCP was 29.0 days (SD = 132.4; range = [6-815]). Eight patients (19.5%) died from surgery-related complications. Among the 33 remaining patients, POPF complete resolution rate was 100% within an average of 120.2 days (SD = 79.6; range = [5-330]) after the first ERCP, after a mean number of ERCP performed per patient of 2.6 (SD = 1.1; range [1-6]). The mean follow-up was 747.8 days (SD = 848.0; range = [2.0-3186.0]) after the first ERCP. No late recurrence of pancreatic leak or collection occurred after the last removal of pancreatic stent.

Conclusions This retrospective study, the most important reported to date, shows that the endoscopic treatment of POPF resistant to medical therapy is an effective option.