Endoscopic ultrasound-guided transgastric drainage of pancreaticopleural fistulas

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis with prevalence of 0.4%. Drainage under endoscopic ultrasound (EUS) guidance may offer an alternative with unassessed efficacy and safety. This case series aimed to initially assess efficacy and safety of EUS-guided transgastric drainage of PPF. This was a retrospective case series that analyzed outcomes of EUS-guided drainage in four patients with PPF. The study was carried out at the Department of General, Gastroenterological, and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Torun (Poland), between 2021–2023. PPF was identified in four patients with chronic pancreatitis. Fistula tracts were arising from the body (2/4;50%), tail (1/4; 25%), and neck (1/4; 25%). Mean fistula diameter and length were 26.25 mm (15–50 mm) and 107.5 (80–150 mm), respectively. Due to inefficiency of conservative treatment and transpapillary drainage in endoscopic retrograde cholangiopancreatography (ERCP), EUS-guided transgastric/transmural drainage of the PPF was performed using metal or plastic stents. Technical and clinical success was achieved in all patients with no adverse events (AEs). Mean hospital stay was 7.75 days (5–12 days), and symptoms resolved in all patients. All stents were removed. There was no recurrence during mean follow-up of 603.5 days (93–1236 days). EUS-guided transgastric drainage appears to be a promising alternative for refractory PPF, resulting in technical and clinical success with minimal AEs. Long-term follow-up underscores sustained symptom resolution and absence of recurrence, highlighting its potential in managing this challenging complication.