%0 Journal Article
%T Nonsurgical Management of Pancreaticopleural Fistula
%A Dhebri AR
%A Ferran N
%J JOP Journal of the Pancreas
%D 2005
%I E S Burioni Ricerche Bibliografiche
%X CONTEXT: Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%. AIM: Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit. METHODS: Patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in MEDLINE and EMBASE. RESULTS: Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases. CONCLUSIONS: A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.
%K Chest Tubes
%K Cholangiopancreatography
%K Endoscopic Retrograde /methods
%K Combined Modality Therapy
%K Digestive System Fistula
%K Drainage /methods
%K Female
%K Gastrointestinal Agents /therapeutic use
%K Humans
%K Male
%K Middle Aged
%K Octreotide /therapeutic use
%K Pancreatic Diseases
%K Pancreatic Fistula /diagnosis/mortality/therapy
%K Pleural Effusion /diagnosis/mortality/therapy
%K Respiratory Tract Fistula /diagnosis/mortality/therapy
%K Stents
%K Survival Analysis
%K Treatment Outcome
%U http://www.joplink.net/prev/200503/13.html