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Comment & Response
January 2018

Nonoperative Management of Pancreatic Fistula—Reply

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
  • 2Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, the Netherlands
JAMA Surg. 2018;153(1):94-95. doi:10.1001/jamasurg.2017.3378

In Reply We appreciate the comments by Baron and Kozarek and this opportunity to discuss the issues raised. The authors, both with a vast experience in endoscopy, make a plea for the use of an endoscopic approach for minimally invasive drainage in patients with postoperative pancreatic fistula. Endoscopic drainage for the management of symptomatic walled-off necrosis in patients with acute pancreatitis has gained popularity over the past years.1,2 We fully agree that endoscopic drainage can also be valuable in the management of symptomatic postoperative pancreatic fistula. However, collections in necrotizing pancreatitis may differ from collections in patients with postoperative pancreatic fistula. The latter frequently occur within the first week after surgery and are often not well encapsulated at the time of clinical indication for drainage, which may require advanced technical endoscopic expertise. To our knowledge, there are currently no studies comparing outcomes of endoscopic drainage with percutaneous catheter drainage in the management of postoperative pancreatic fistula. This might be an explanation for the limited use of endoscopic drainage in our practice in the Netherlands.

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