Transcatheter fistula tract occlusion: a safe and effective treatment for grade B postoperative pancreatic fistula

Asymptomatic low-output postoperative pancreatic fistula (POPF) often heal spontaneously within 21 days following surgery and are reported as cases of “biochemical leak.” However, some POPFs, especially those with high-output drainage frequently require more than 21 days to heal and are designated as grade B POPF. The reported frequency of grade B POPFs ranges from 16.4% to 22.1%. In addition to prolonged drainage, a majority of cases require enteral/parenteral nutrition and/or somatostatin analogs to decrease output and accelerate closure. Complications associated with grade B POPF include increased hospital stay, costs, and patient discomfort. Grade B POPF is inevitable among certain patients following pancreatectomy; therefore, measures to accelerate closure and minimize clinical impact of this complication are required. The most frequently employed strategy for this purpose is the gradual withdrawal of the drainage tube (at 2 cm every several days) for clinically stable patients, while allowing for enteral feeding. However, this strategy induces discomfort and maintaining the drain in place is difficult; repeated traction of the drain apparatus from the sutured skin results in pain. Moreover, the final removal of the drain remains a prolonged process; the presumed rationale of gradual withdrawal is to permit closure from the inside out and prevent formation of residual abscesses following removal. However, recurrent POPFs or residual abscesses still occur in a few patients who underwent gradual withdrawal of drains. Thus, to accelerate closure of a well-developed, high-output POPF tract and avoid residual abscess, we developed a novel technique using transcatheter fistula tract occlusion (TCFTO). The present study reported TCFTO performed on 21 consecutive patients with asymptomatic grade B POPF.