Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy

Background: Pancreatic fistula (PF) is the most common postoperative complication after distal pancreatectomy (DP). Endoscopic pancreatic sphincterotomy and drainage have been shown to be an effective treatment for PF. Recently, preoperative endoscopic pancreatic stenting was proposed to prevent PF, but there are no controlled trials so far. Objective: We investigated whether preoperative pancreatic sphincterotomy and stenting could prevent the development of PF in patients with DP. Design: Nonrandomized cohort study with a prospective endoscopic intervention group and a retrospective control group. Setting: Single-center academic teaching hospital. Patients: Preoperative endoscopic pancreatic sphincterotomy and stenting were intended to prevent PF after DP in 25 patients between July 2004 and October 2008. The incidence of PF was compared with that in a control group of 23 patients who underwent DP between January 2001 and March 2004 without preoperative endoscopic intervention. Interventions: Pancreatic sphincterotomy and stenting. Main Outcome Measurement: PF rate. Results: Overall, a cohort of 48 patients underwent DP between January 2001 and October 2008. In all 25 patients who underwent preoperative endoscopic pancreatic intervention, sphincterotomy was successfully performed, and stenting of the pancreatic duct was successful in 23 patients. PF developed in none of the 25 patients in the endoscopic intervention group. In the 23 patients without preoperative endoscopic intervention, a PF developed in 5 patients (22%) (P = .02). Limitations: Nonrandomized design, retrospective control group. Conclusions: Preoperative pancreatic sphincterotomy and stenting were a feasible and safe procedure in this series. Prophylactic preoperative endoscopic intervention may decrease PF rates after DP. (Gastrointest Enclose 2010;72:536-42.)