Bile fistulas
The management of biliary fistulas is done by lowering the pressure at the level of the bile duct. This is achieved by extracting the bile duct stones, if any, by means of a papillotomy or by placing a stent. The most difficult cases to manage are those in which the fistula is associated with a stricture, which must be treated to achieve closure.
Pancreatic Fistulas
Pancreatic fistula after PAF wound in abdomen, with pancreatic involvement. The Wirsung is compromised but not sectioned, as evidenced by the passage of the contrast medium towards the tail of the gland. It is handled by passing a hydrophilic guide through the fistula site and leaving a distal stent.
Pancreatic fistulas are also a complication derived from various inflammatory, traumatic, postoperative or iatrogenic disorders. The rupture of a pancreatic duct causes fluid leakage that is collected in different internal spaces or lost outward through spontaneous orifices created by surgery or percutaneous drainage.
Although spontaneous closure of the fistulas is common, some may be complicated by the formation of necrosis, abscesses, pseudocysts or hemorrhages due to pseudoaneurysms.
Pancreatic fistulas are also a dreaded complication of acute pancreatitis, chronic pancreatitis and pancreatic surgery.
ERCP can be used as a diagnostic and therapeutic method due to the high clinical suspicion of fistulas.
The endoscopic techniques described for the management of fistulas include application of fibrin gum or N-butyl-2-cyanoacrylate and the establishment of prostheses when transpapillary approach is possible. The drainage of collections, abscesses and pseudocysts is also possible through endoscopy. Endoscopic drainage with prosthesis seeks the mechanical closure of the fistula in addition to releasing pressure within the pancreatic duct, allowing greater flow to the duodenum and achieving closure, in most cases, in less than ten days.