Efficacy and Safety of Endoscopic Pancreatic Stenting for Traumatic Pancreatic Fistula.

Abstract

Objective: Traumatic pancreatic fistula is challenging and complicated to manage. Our aim was to assess the efficacy of endoscopic pancreatic duct stenting in the treatment of traumatic pancreatic fistula.

Methods: Patients with pancreatic trauma treated by endoscopic pancreatic duct stenting at Jinling Hospital from May 2016 to October 2022 were enrolled. We recorded clinical data, the cause of pancreatic trauma, the location of injuries, pancreatic injury grade, the timing and duration of stent placement and removal, and long-term outcomes.

Results: Twenty-six patients with traumatic pancreatic fistula who underwent 33 endoscopic pancreatic duct stenting procedures were enrolled. Most patients (20/26, 76.9%) were grade IV. The median time interval from injury to endoscopic stenting was 48 (range: 1 to 959) days. The main pancreatic duct (MPD) was visualized in all patients, and the average diameter of the MPD was 1.73±0.45 mm. Serum amylase levels, drain amylase levels, and drainage volume were significantly decreased after stent placement. One patient had a pancreatic duct stricture at the neck, 1 patient had poor drainage after stenting, and there were no other complications. The technical success rate was 93.9% (31/33), and the clinical efficacy rate was 76.9% (20/26). Univariate analysis revealed that the interval from injury to stenting (HR: 10.500, 95% CI: 1.115-98.914, P=0.040) was associated with stent success.

Conclusion: Pancreatic duct stenting is a safe and effective treatment modality and should be an optional treatment for the management of traumatic pancreatic fistula. Before stent placement, the duration of pancreatic fistula should be assessed since it is related to fistula healing.