Internal pancreatic fistula is an uncommon but serious complication of chronic pancreatitis, arising when disruption or stenosis of the pancreatic duct allows pancreatic secretions to track into adjacent body cavities. Managing this condition requires a targeted approach directed at the underlying ductal pathology.
The protocol addresses patients with chronic pancreatitis in whom an internal pancreatic fistula has developed as a complication — a setting in which standard supportive care alone is insufficient and ductal intervention is indicated as the first step.
The recommended initial intervention involves an endoscopic procedure targeting the pancreatic duct:
Full procedural details, sequencing, and criteria for escalation are available in the structured protocol.
Placement of a pancreatic duct stent is recommended as the initial treatment for internal pancreatic fistula.
Endoscopic insertion of a pancreatic duct stent (± conventional conservative treatment) is recommended as the first choice for treatment of internal pancreatic fistula and surgery for nonresponsive cases after 3–6 weeks of follow-up.
The results of treatment are improved by inserting a stent beyond the site of disruption/stenosis in the pancreatic duct.
View source ↗