Expanding endoscopic treatment strategies for pancreatic leaks following pancreato-duodenectomy: a single centre experience

Endoscopic management of postoperative pancreatic fistula after pancreaticoduodenectomy: a single center retrospective analysis

BACKGROUND

Indications and outcomes of endoscopic approaches in treating postoperative pancreatic fistula (POPF) are underinvestigated. The present study aimed to evaluate the outcomes of patients undergoing endoscopic treatment for POPF following pancreaticoduodenectomy (PD).

METHODS

Data of consecutive patients undergoing PD between 2014 and 2024 were retrospectively analyzed. Patients with POPF treated by an endoscopic approach were selected. The primary endpoint was clinical efficacy of the endoscopic approach. Secondary endpoints were variables associated with clinical efficacy of endoscopic treatment.

RESULTS

During the study period, a total of 436 patients underwent PD. Overall POPF rate was 18.4%. Twenty-one patients with POPF underwent endoscopic treatment and composed the study cohort. The median timing for endoscopic treatment was 20 postoperative days (POD). The types of endoscopic treatments performed included: trans-anastomotic intraductal pancreatic stent (23.8%); lumen apposing metal stent (LAMS) through the pancreatico-jejunal (PJ) anastomotic dehiscence (23.8%); large caliber aspirating nose-to-retroperitoneum tube through the PJ anastomosis leak (9.5%); triple metal stenting (enteral + biliary + pancreatic) (9.5%); transgastric LAMS close to pancreatic stump (14.3%); nose-to-retroperitoneum tube into a LAMS placed through PJ dehiscence (9.5%); transgastric LAMS near the pancreatic stump associated with an intraductal pancreatic trans-anastomotic stent (9.5%). Technical and clinical success rate were 100% and 71.4%, respectively. After endoscopic treatment, 19% of patients underwent surgical reoperation and 9.5% died. Timing of endoscopic treatment was the only factor associated with clinical success (POD 20 vs POD 13.5; p = 0.039).

CONCLUSION

Endoscopy can be an effective option for managing POPF after PD with a clinical success rate of 71.4%. Proper patient selection and the timing of intervention are key to achieving good clinical outcomes. Higher success rate was seen for endoscopic treatment performed after the 20th POD.

[Endoscopic management of complications in the hepatobiliary and pancreatic system and the tracheobronchial tree]

Endoscopic methods are nowadays a priceless tool for the treatment of postoperative complications after hepatobiliary, pancreatic and thoracic surgery. Endoscopic decompression of the biliary tract is the treatment of choice for biliary duct leakage after cholecystectomy, hepatic resection or liver transplantation. Postoperative biliary duct stenosis can also be successfully treated by endoscopic balloon dilatation and implantation of various endoprostheses in most of the patients. In the case of pancreatic fistulas, especially those occurring after central or distal pancreatic resections, endoscopic decompression of the pancreatic duct can significantly contribute to rapid healing. Additionally, interventional endosonography provides a valuable treatment option for transgastric drainage of postoperative fluid collections, which often accompany a pancreatic fistula. Various treatment alternatives have been described for the bronchoscopic treatment of bronchopleural and tracheoesophageal fistulas, which often lead to the rapid alleviation of symptoms and often to the definitive closure of the fistula.