Targeted transgastric drainage of persistent pancreaticocutaneous - - PowerPoint PPT Presentation

▶
targeted transgastric drainage of persistent
SMART_READER_LITE
LIVE PREVIEW

Targeted transgastric drainage of persistent pancreaticocutaneous - - PowerPoint PPT Presentation

Jan 28, 2023 169 likes •439 views

Targeted transgastric drainage of persistent pancreaticocutaneous fistulas F. Edward Boas, Peter Kelly, Jeffrey A. Drebin, Charles M. Vollmer, and Richard D. Shlansky Goldberg SIR, 2014 03 23 Disclosures None Pancreaticocutaneous

slide-1
SLIDE 1

Targeted transgastric drainage of persistent pancreaticocutaneous fistulas

  • F. Edward Boas, Peter Kelly, Jeffrey A. Drebin,

Charles M. Vollmer, and Richard D. Shlansky‐Goldberg SIR, 2014‐03‐23

slide-2
SLIDE 2

Disclosures

  • None
slide-3
SLIDE 3

Pancreaticocutaneous fistula

slide-4
SLIDE 4

Conservative treatment

  • Jejunal feeds
  • TPN
  • Somatostatin analogues
  • Pancreatic duct stent
  • Pseudocyst drain
slide-5
SLIDE 5

Surgical treatment

Conservative treatment is likely to fail if: complete pancreatic duct transection, downstream ductal stricture, high‐output fistula

  • Cystgastrostomy
  • Distal pancreatectomy
  • Pancreaticojejunostomy
slide-6
SLIDE 6

Goal

Drain the pancreatic duct directly into the stomach, using a snare target technique

slide-7
SLIDE 7

Pancreatic tail drain

slide-8
SLIDE 8

Pancreatic tail drain

slide-9
SLIDE 9

Pancreatic tail drain

slide-10
SLIDE 10

Pancreatic tail drain

slide-11
SLIDE 11

Pancreatic tail drain

slide-12
SLIDE 12

Pancreatic tail drain

slide-13
SLIDE 13

Pancreatic duct drain

slide-14
SLIDE 14

Pancreatic duct drain

slide-15
SLIDE 15

Pancreatic duct drain

slide-16
SLIDE 16

Pancreatic duct drain

slide-17
SLIDE 17

Pancreatic duct drain

slide-18
SLIDE 18

Pancreatic duct drain

slide-19
SLIDE 19

Pancreatic duct drain

slide-20
SLIDE 20

Pancreatic duct drain

slide-21
SLIDE 21

Pancreatic duct drain

slide-22
SLIDE 22

Pancreatic duct drain

slide-23
SLIDE 23

Methods

  • 6 patients with pancreaticocutaneous fistulas
  • 5 patients with pancreatitis
  • 1 patient status post ganglioneuroma resection
  • All patients failed conservative therapy
  • Transgastric pancreatic duct or fistula drains kept in

place for an average of 4 months

slide-24
SLIDE 24

Methods

slide-25
SLIDE 25

Results

  • 4 of 6 patients: Fistula resolved (average 27 month

follow up)

  • 1 of 6 patients: cystenterostomy
  • 1 of 6 patients: percutaneous cystgastrostomy
slide-26
SLIDE 26

Conclusions

  • Refractory pancreatic fistulas can be managed with

transgastric pancreatic duct drains

  • Non‐dilated pancreatic ducts can be accessed using

a snare‐target technique

  • Transgastric drains allow for internal drainage of

the pancreatic duct