The role of endoscopic retrograde pancreatography in pancreatic trauma: a critical appraisal of 48 patients treated at a tertiary institution.

BACKGROUND: Endoscopic retrograde pancreatography (ERP) is useful in the diagnosis and treatment of selected patients with pancreatic trauma. We analyzed the role of ERP in treating persistent complications of pancreatic injuries at a tertiary institution.

METHODS: Patients with pancreatic trauma who underwent ERP were identified from a prospective database of 426 pancreatic injuries from January 1983 to January 2011. Patient demographics, mechanism of injury, time to presentation, method of diagnosis, associated injuries, clinical management, endoscopic interventions and their timing, surgical treatment, and patient outcomes were evaluated.

RESULTS: Forty-eight patients underwent ERP after blunt (n = 26) or penetrating (n = 22) pancreatic injury. Median time from injury to ERP was 38 days (range, 2-365 days). Diagnostic ERP was successful in 47 patients. In 11 patients, ERP demonstrated an intact main duct with minor peripheral injuries, and no further intervention was required. A pancreatic fistula was demonstrated in 24, a main pancreatic duct stricture in 12, and a pseudocyst in 10 patients. Fifteen patients had a pancreatic duct sphincterotomy, seven had a pancreatic stent inserted, and six had an endoscopic pseudocyst drainage. Ten patients ultimately required surgery, seven of whom had demonstrated a severe pancreatic duct stricture. Operations performed following ERP were distal pancreatectomy (n = 6), pancreaticojejunostomy (n = 3) and cyst-jejunostomy (n = 1).

CONCLUSION: ERP allowed one quarter of the patients to be treated conservatively. Half had a successful intervention by ERP. Success was most likely in those with fistulae and pseudocysts. Surgery was ultimately avoided in more than three quarters of the patients.

LEVEL OF EVIDENCE: Therapeutic study, level V.