Pancreatic Leaks and Fistulae: Pathophysiological Principles.
Pancreatic fistula is one of the common
complications that may arises after
upper gastrointestinal surgery, acute pancreatitis and,
more rarely, abdominal traumas. The treatment
is mainly based on conservative
therapy. However, for persistent ones, endoscopical
management is now-a-days considered as the
surgical one. In this brief discussion, we want to
focus the pathophysiological
bases of endoscopic treatment for pancreatic leaks and fistulas.
Pancreatic duct leaks and fistulae can lead to significant
morbidity and mortality. Traditionally, pancreatic
fistulas are managed conservatively
with fluid drainage, general support, total parenteral
nutrition, and pancreatic secretion inhibitors. This strategy
can effectively heal most of the low volume leaks.
For persistent leaks, traditionally, surgical
treatment is considered as the treatment
of choice. Recently, there is a
trend towards more aggressive
medical management, to avoid surgery. Endoscopic transpapillary or
transmural treatment and resolution of pancreatic leaks are now
frequently reported, making pancreatic endotherapy a key player in
the management of pancreatic leaks and fistulae.
Most biliary leaks and fistulas are traditionally treated by
endoscopy. There are many similarities
but also crucial differences in the
treatment of biliary and pancreatic leaks. The
differences lie in the physiology of biliary and
pancreatic secretion. Bile is secreted by hepatocytes
by cholangiocytes by secretory
and reabsorptive processes as bile
passes through the ducts.
Bile production is more or less a constant
process with little extrahepatic regulation.
The mean basal flow of bile in humans is approximately 620 mL/d or 25 mL/h.
Pancreas Open J. 2017; 2(1): e3-e4. doi: 10.17140/POJ-2-e006