Management of Refractory Pancreatic Fistula: A Review of Literature

Abstract

BackgroundChronic non-healing or refractory pancreatic fistulae are rare complications of pancreatic surgery (pancreaticoduodenectomy, distal pancreatectomy) or pancreatitis. Materials and MethodsWe conducted a thorough literature search of electronic databases such as PubMed, Google Scholar, BioMed Central, and Co-chrane Library using the keywords and medical subject headings (MeSH) terms “chronic pancreatic fistula”, “post-operative fistula”, “fistula management” and “refractory pancreatic fistula”. The purpose of this review is to evaluate the management options for refrac-tory pancreatic fistula (PF).ResultsLiterature reveals that refractory pancreatic fistulae have been managed by techniques like endoscopic ultrasound (EUS)-guided techniques like transmural puncture by clamping, puncture of the fistula tract, transmural placement of pigtail stent, and EUS-guided pancreaticogastrostomy. Other techniques are postoperative endoscopic pancreatic stent placement in Grade C pancreatic fistula, intestinal decompression catheter insertion into the jejunum, embedding fistulojejunostomy, and fistulojejunostomy.ConclusionIn conclusion, embedding fistulojejunostomy, EUS-guided transmural puncture by clamping, and EUS-guided transmural place-ment of pigtail stent are effective techniques for the management of refractory pancreatic fistulae. Yet further studies in a larger population are recommended.