---
title: "Endoscopic Drainage for Postoperative Pancreatic Fistula After Distal Pancreatectomy"
id: "pubmed-42674704"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42674704"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42674704/"
doi: "10.21873/anticanres.18368"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Endoscopic Drainage for Postoperative Pancreatic Fistula After Distal Pancreatectomy
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42674704
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42674704/)
- **DOI:** [10.21873/anticanres.18368](https://doi.org/10.21873%2Fanticanres.18368)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study of 122 patients who underwent **distal pancreatectomy (DP)** at a single institution between April 2016 and February 2025; pancreatic fistulas defined by International Study Group for Pancreatic Surgery criteria. - Surgical approaches: open (29 patients, 23.8%), laparoscopic (77 patients, 63.1%), and robot-assisted (16 patients, 13.1%). - Postoperative pancreatic fistula (POPF) grade B/C occurred in 29 patients (23.8%): 9 after open (31.3%), 17 after laparoscopic (22.1%), and 3 after robot-assisted surgery (18.8%). - Postoperative intra-abdominal infection occurred in 26 patients (21.3%): rates by approach were 24.1% open, 19.5% laparoscopic, and 25% robot-assisted. - Among the 29 POPF cases, 14 patients (48.3%) underwent endoscopic drainage via percutaneous transpapillary or transgastric approaches; 6 patients (42.9% of those treated endoscopically) required combined management. - Drainage breakdown: transpapillary in 6 patients (42.9%), transgastric in 5 patients (35.7%), and combined drainage in 3 patients (21.4%). - Reported mean post-treatment hospital stays: transpapillary 18.3 ± 2.7 days; transgastric 12.9 ± 6.4 days; combined drainage 49.2 ± 5.3 days. - Statistical findings: the **transgastric drainage** group had a significantly shorter hospital stay (p = 0.0350); the drain tube management group had a significantly longer stay (p < 0.0001). - Authors conclude **transgastric drainage** is useful for POPF and intra-abdominal infection after DP and may enable earlier improvement, but note ongoing challenges including postoperative hemorrhage, pseudoaneurysm bleeding, and high medical costs. - Keywords reported: Distal pancreatectomy; **LAMS**; POPF; drainage; intra-abdominal infection.
## Clinical Analysis & Structured Key Points
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cubicseal@gmail.com."), [Ryosuke Minagawa](https://pubmed.ncbi.nlm.nih.gov/?term=Minagawa+R&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Yuriko Tsutsui](https://pubmed.ncbi.nlm.nih.gov/?term=Tsutsui+Y&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Shojiro Kawano](https://pubmed.ncbi.nlm.nih.gov/?term=Kawano+S&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Tomohiro Furukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Furukawa+T&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Shun Kurose](https://pubmed.ncbi.nlm.nih.gov/?term=Kurose+S&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Daisuke Matsuda](https://pubmed.ncbi.nlm.nih.gov/?term=Matsuda+D&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Yoshinari Nobuto](https://pubmed.ncbi.nlm.nih.gov/?term=Nobuto+Y&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Hiroko Yano](https://pubmed.ncbi.nlm.nih.gov/?term=Yano+H&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Yuichiro Kajiwara](https://pubmed.ncbi.nlm.nih.gov/?term=Kajiwara+Y&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Nobuaki Azemoto](https://pubmed.ncbi.nlm.nih.gov/?term=Azemoto+N&cauthor_id=42674704)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-3 "Center for Liver-Biliary-Pancreatic Disease, Matsuyama City, Japan."), [Terutoshi Yamaoka](https://pubmed.ncbi.nlm.nih.gov/?term=Yamaoka+T&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Tomoyuki Yokota](https://pubmed.ncbi.nlm.nih.gov/?term=Yokota+T&cauthor_id=42674704)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-3 "Center for Liver-Biliary-Pancreatic Disease, Matsuyama City, Japan."), [Kazuhito Minami](https://pubmed.ncbi.nlm.nih.gov/?term=Minami+K&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Takashi Nishizaki](https://pubmed.ncbi.nlm.nih.gov/?term=Nishizaki+T&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#full-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan.") Affiliations Expand ### Affiliations * 1 Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan; cubicseal@gmail.com. * 2 Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan. * 3 Center for Liver-Biliary-Pancreatic Disease, Matsuyama City, Japan. * PMID: **42674704** * DOI: [ 10.21873/anticanres.18368 ](https://doi.org/10.21873/anticanres.18368) Item in Clipboard # Endoscopic Drainage Strategies for Postoperative Pancreatic Fistula Following Distal Pancreatectomy Koichi Kimura et al. Anticancer Res. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID Anticancer Res Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anticancer+Res%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Anticancer+Res%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42674704/) . 2026 Sep;46(9):5239-5247. doi: 10.21873/anticanres.18368. ### Authors [Koichi Kimura](https://pubmed.ncbi.nlm.nih.gov/?term=Kimura+K&cauthor_id=42674704)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-1 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan; cubicseal@gmail.com."), [Ryosuke Minagawa](https://pubmed.ncbi.nlm.nih.gov/?term=Minagawa+R&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Yuriko Tsutsui](https://pubmed.ncbi.nlm.nih.gov/?term=Tsutsui+Y&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Shojiro Kawano](https://pubmed.ncbi.nlm.nih.gov/?term=Kawano+S&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Tomohiro Furukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Furukawa+T&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Shun Kurose](https://pubmed.ncbi.nlm.nih.gov/?term=Kurose+S&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Daisuke Matsuda](https://pubmed.ncbi.nlm.nih.gov/?term=Matsuda+D&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Yoshinari Nobuto](https://pubmed.ncbi.nlm.nih.gov/?term=Nobuto+Y&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Hiroko Yano](https://pubmed.ncbi.nlm.nih.gov/?term=Yano+H&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Yuichiro Kajiwara](https://pubmed.ncbi.nlm.nih.gov/?term=Kajiwara+Y&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Nobuaki Azemoto](https://pubmed.ncbi.nlm.nih.gov/?term=Azemoto+N&cauthor_id=42674704)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-3 "Center for Liver-Biliary-Pancreatic Disease, Matsuyama City, Japan."), [Terutoshi Yamaoka](https://pubmed.ncbi.nlm.nih.gov/?term=Yamaoka+T&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Tomoyuki Yokota](https://pubmed.ncbi.nlm.nih.gov/?term=Yokota+T&cauthor_id=42674704)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-3 "Center for Liver-Biliary-Pancreatic Disease, Matsuyama City, Japan."), [Kazuhito Minami](https://pubmed.ncbi.nlm.nih.gov/?term=Minami+K&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan."), [Takashi Nishizaki](https://pubmed.ncbi.nlm.nih.gov/?term=Nishizaki+T&cauthor_id=42674704)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42674704/#short-view-affiliation-2 "Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan.") ### Affiliations * 1 Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan; cubicseal@gmail.com. * 2 Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Japan. * 3 Center for Liver-Biliary-Pancreatic Disease, Matsuyama City, Japan. * PMID: **42674704** * DOI: [ 10.21873/anticanres.18368 ](https://doi.org/10.21873/anticanres.18368) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background/aim:** Pancreatic fistula following distal pancreatectomy (DP) is a significant postoperative complication associated with high mortality and challenging treatment. Moreover, no optimal drainage method has yet been established. This study reports the current status and treatment approaches for pancreatic fistula following DP at our institution. **Patients and methods:** We included 122 patients who underwent DP at our hospital between April 2016 and February 2025. Pancreatic fistulas were defined according to International Study Group for Pancreatic Surgery criteria. **Results:** The procedures performed for DP included open surgery (29 patients; 23.8%), laparoscopic surgery (patients; 63.1%), and robot-assisted surgery (16 patients; 13.1%). Postoperative pancreatic fistulas (POPF; grade B/C) occurred in 29 cases (23.8%) [9 (31.3%) open surgery, 17 (22.1%) laparoscopic surgery, and 3 (18.8%) robot-assisted surgery]. Postoperative intra-abdominal infections occurred in 26 patients (21.3%): [7 (24.1%) open surgery, 15 (19.5%) laparoscopic surgery, and 4 (25%) robot-assisted surgery]. Among patients presenting with POPFs, 14 (48.3%) required percutaneous transpapillary or transgastric drainage, and 6 (42.9%) required combined management. Transpapillary, transgastric, and combined drainage were performed in six (42.9%), five (35.7%), and three (21.4%) patients, respectively. Post-treatment hospital stays for these groups were 18.3±2.7, 12.9±6.4, and 49.2±5.3 days, respectively. The transgastric drainage group had a significantly shorter hospital stay (_p_ =0.0350), whereas the drain tube management group had a significantly longer hospital stay (_p_ <0.0001). **Conclusion:** Transgastric drainage is a useful treatment for pancreatic fistula and intra-abdominal infection following DP and may allow early improvement. However, postoperative hemorrhage, pseudoaneurysm bleeding, and high medical costs remain challenges. **Keywords:** Distal pancreatectomy; LAMS; POPF; drainage; intra-abdominal infection. Copyright © 2026 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved. 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