Diagnosis, treatment and prophylaxis of pancreatic fistulas in severe necrotizing pancreatitis and the long-term outcome of acute pancreatitis

Acute infected necrotizing pancreatitis (ANP) is a very complex disease with a high risk of complications and death. ANP is difficult to treat and is often associated with poor outcomes. Despite the increasing data on the technical details required to perform a mini-invasive necrosectomy for infected pancreatic necrosis, relatively few studies have focused on the presence and consequences of pancreatic fistula (PF) in the context of APN. Moreover, the long-term prognosis of patients with acute pancreatitis (AP) is scant.

The results of this study confirm that PF is common in patients after a surgical necrosectomy and the diagnosis of PF is challenging in infected situations. The results also confirm that endoscopic pancreatic ductal stenting (EPDS) is a good treatment for PF after necrosectomy, but the prevention of PF with prophylactic EPDS in ANP seems to be harmful for patients. The long-term outcome of AP, particularly alcohol AP, was associated with high mortality. This all indicates that for patients with infected ANP, a PF must be considered in the treatment, but the prevention of a pancreatic ductal leak with prophylactic stenting cannot be recommended. In addition, long-term mortality among patients with AP (mainly alcohol-induced) was four times higher than within the age-and sex-matched control population.