Classification and endoscopic management of pancreatic fistulas

Pancreatic fistula is a common and serious complication that may occur after pancreatic surgery, pancreatitis, trauma, or pancreatic intervention.It can lead to persistent external drainage, pancreatic fluid collections, infection, bleeding, nutritional depletion, repeated interventions, and sepsis.Endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary pancreatic duct stenting is widely used, but its effectiveness depends mainly on ductal continuity, leak location, successful stent placement across the ductal disruption, and the presence of disconnected pancreatic duct syndrome or associated collections.When ductal continuity is lost, the leak cannot be bridged, or mature collections and surgically altered anatomy are present, ERCP alone may be insufficient.In these situations, endoscopic ultrasound (EUS)-guided transmural drainage, EUS-guided pancreatic duct drainage, rendezvous techniques, fistula internalization, and combined approaches may provide alternative or complementary routes for internal drainage.This minireview summarizes current endoscopic strategies for pancreatic fistula and proposes an endoscopy-oriented classification framework to guide treatment selection.