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The following is a summary of “Endoscopic main duct stenting in refractory postoperative pancreatic fistula after distal pancreatectomy – a friend or a foe?,” published in the January 2024 issue of Surgery by Linder et al.

In this study, the researchers investigated clinically relevant postoperative pancreatic fistula (CR POPF) following distal pancreatectomy (DP), a common occurrence with limited exploration of endoscopic treatment (ET). The primary objectives were to assess risk factors associated with CR POPF after DP and evaluate the efficacy of ET as an adjunct to standard therapy. From 2011 to 2020, 406 patients who underwent DP without prior pancreatic surgery were consecutively evaluated for CR POPF risk factors. The study incorporated non-standardized ET, specifically main pancreatic duct (MPD) stenting, and recorded healing times and ET-related complications. CR POPF was observed in 29.6% of patients, and ET was conducted in 17 individuals with a median interval of 27 days post-surgery. Factors such as ASA-PS 1–2, MPD ≤ 3 mm, procedure duration ≥ 3 h, and CRP ≥ 180 on postoperative day 3 were identified as risk indicators for CR POPF. 

The resolution of POPF with standard treatment took 32 and 59 days in the ET group, revealing no significant benefit from ET (p < 0.001). Although one mortality occurred in the ET group, unrelated to the procedure, mild post-ERCP pancreatitis affected three patients. In conclusion, CR POPF is a frequent outcome following DP, with risk factors including extended operating time, a narrow MPD, lower ASA scores, and elevated postoperative CRP levels. Despite ET not demonstrating substantial benefits, the evaluation was constrained by a limited number of patients and non-standardized treatment protocols. Notably, complications associated with ET were mild.

Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-023-02233-x