Abstract
We describe a case of pancreatic fistula following pancreaticoduodenectomy successfully treated by performing endoscopic ultrasound-guided fistulogastrostomy using metallic stent. A 65-year-old man underwent pancreaticoduodenectomy for pancreatic cancer. On the 8th day after surgery, a re-operation was performed for the leakage of pancreatic juice from the pancreaticojejunal anastomosis, and a drainage tube was placed near the anastomosis. Leakage of pancreatic juice through the tube continued despite the administration of octreotide. The obstruction of the pancreaticojejunal anastomosis was suspected because of low amylase concentration in the jejunal juice, suggesting that another strategy to control pancreatic leakage was necessary. Stent insertion for the obstructed pancreaticojejunal anastomosis was attempted but failed due to bending of the jejunum. To achieve internal drainage, a metallic stent (Niti-S full-cover stent) was inserted into the pancreatic fistula through the stomach wall under the guidance of endoscopic ultrasonography. After endoscopic fistulogastrostomy, the pancreatic leakage completely disappeared and the patient was discharged without any symptoms. Endoscopic ultrasound-guided fistulogastrostomy using a metallic stent may be a useful alternative for the treatment of pancreatic fistula.
