Management of pancreatic ascites complicating alcoholic chronic pancreatitis - 16/01/21

Doi : 10.1016/j.jviscsurg.2020.11.015

L. Schneider Bordat ^a,⁎ , M. El Amrani ^a, S. Truant ^a, J. Branche ^b, P. Zerbib ^a
^a Department of digestive surgery and transplantation, university of Lille Nord de France, Claude-Huriez Hospital, CHU de Lille, rue Michel-Polonowski, 59037 Lille, France
^b Gastroenterology department, university of Lille Nord de France, Claude-Huriez Hospital, CHU de Lille, 59037 Lille, France

^⁎Corresponding author.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 16 January 2021
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Highlights

•	PA is a rare complication of alcoholic chronic pancreatitis (CP) that results in significant morbidity and mortality.
•	An initial morphological assessment is essential, particularly to determine the severity of the underlying pancreatitis and to obtain a precise topography of the lesion.
•	Conservative medical treatment seems to be ineffective and, if it fails, should be followed by a second-line endoscopic sphincterotomy±endoprosthesis insertion.
•	Surgery is a last-line treatment, but should be considered earlier if endoscopic treatment is not possible and in cases of associated necrotising pancreatitis.
•	Surgery is most often necessary for pancreatico-pleural effusion associated with PA.

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Summary

Introduction

Pancreatic ascites (PA) is an unusual and little studied complication of chronic alcoholic pancreatitis. Management is complex and is based mainly on empirical data. The aim of this retrospective work was to analyse the management of PA at our centre.

Patients and methods

A total of 24 patients with PA complicating chronic alcoholic pancreatitis were managed at the Lille University Hospital between 2004 and 2018. Treatment was initially medical and then, in case of failure, interventional (endoscopic, radiological and/or surgical). Data regarding epidemiology, therapeutic and follow-up data were collected retrospectively.

Results

Twenty-four patients were analysed; median follow-up was 18.5 months [6.75–34.25]. Exclusively medical treatment was effective in three of four patients, but, based on intention to treat, medical therapy alone was effective in only two out of 24 patients. Of 17 patients treated endoscopically, treatment was successful in 15 of them. Of the 15 who underwent surgery, external surgical drainage was effective in 13. Multimodal treatment, initiated after 6.5 days [4–13.5] of medical treatment, was effective in 12 out of 14 patients. In total, 21 patients were successfully treated (87%) with a morbidity rate of 79% and a mortality rate of 12.5% (n=3).

Conclusion

PA gives rise to significant morbidity and mortality. Conservative medical treatment has only a limited role. If medical treatment fails, endoscopic and then surgical treatment allow a favourable outcome in more than 80% of patients.

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Keywords : Pancreatic ascites, Chronic alcoholic pancreatitis, Pancreatic duct rupture, Pseudocyst