Transgastric pancreatic duct drains

Refractory pancreaticocutaneous fistulas can be managed by placing a snare into the duct via the cutaneous fistula, providing a target for percutaneous puncture and drainage of the duct into the stomach. This reconnects the pancreas to the gastrointestinal tract, diverting pancreatic fluid away from the fistula, and allowing it to heal.

Methods for draining the pancreatic duct into the stomach are shown below:

View the:

Paper (author's version)
Paper (JVIR)

Scrollable CT of a transgastric pancreatic duct drain

Boas FE, Kelly P, and Shlansky-Goldberg R. (2014) "Targeted transgastric drainage of persistent pancreaticocutaneous fistulas." JVIR 25(3): S41. Presented at SIR, San Diego, 2014-03-23.

Boas FE, Kadivar F, Kelly PD, Drebin JA, Vollmer CM, Shlansky-Goldberg RD. (2015) "Targeted transgastric drainage of isolated pancreatic duct segments to cure persistent pancreaticocutaneous fistulas from pancreatitis." J Vasc Interv Radiol. 26(2):247-51.

Chronic pancreaticocutaneous fistulas can be difficult to treat. This paper presents a snare-target technique for draining a non-dilated pancreatic duct into the stomach, thus diverting pancreatic fluid away from the pancreaticocutaneous fistula to allow it to heal. Internal or internal/external transgastric pancreatic duct or fistula drains were placed in 6 patients. After an average of 4 months of drainage, all 6 patients had resolution of the cutaneous fistula. 2 patients developed a pseudocyst but no recurrent fistula after drain removal, and the other 4 had no pseudocyst or fistula after an average of 27 months follow up (range 6-74 months).

Keywords: pancreatic fistula, pancreatic duct injury, pseudocyst, transgastric drain, snare

Return to the main page