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He ZY, Chen DX, Zhai YQ, Li MY. Classification and endoscopic management of pancreatic fistulas. World J Gastrointest Endosc 2026; 18(11): 126239 [DOI: 10.4253/wjge.126239]
World J Gastrointest Endosc. Nov 16, 2026; 18(11): 126239 Published online Nov 16, 2026. doi: 10.4253/wjge.126239
Classification and endoscopic management of pancreatic fistulas
Zi-Yi He, De-Xin Chen, Ya-Qi Zhai, Ming-Yang Li
Zi-Yi He, School of Medicine, Nankai University, Tianjin 300071, China
De-Xin Chen, Ya-Qi Zhai, Ming-Yang Li, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Co-first authors: Zi-Yi He and De-Xin Chen.
Co-corresponding authors: Ya-Qi Zhai and Ming-Yang Li.
Author contributions: He ZY and Chen DX contributed equally to this work, as they are co-first authors; He ZY and Chen DX performed the literature search and drafted the manuscript; Li MY and Zhai YQ conceived the review, critically revised the manuscript, and supervised the work; Li MY and Zhai YQ contributed equally to correspondence, supervision, and responsibility for the work, as they are co-corresponding authors.
AI contribution statement: Portions of this manuscript were edited using ChatGPT (OpenAI) solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by the Military High-level Scientific and Technological Innovation Talent Project 2024, No. GCCRC-2024-011.
Conflict-of-interest statement: All authors declare that the manuscript was prepared in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Corresponding author: Ming-Yang Li, MD, Doctor, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. mingyangli_pla@163.com
Received: July 29, 2026 Revised: October 7, 2026 Accepted: October 28, 2026 Published online: November 16, 2026 Processing time: 107 Days and 17.2 Hours
Abstract
Pancreatic fistula is a common and serious complication that may occur after pancreatic surgery, pancreatitis, trauma, or pancreatic intervention. It can lead to persistent external drainage, pancreatic fluid collections, infection, bleeding, nutritional depletion, repeated interventions, and sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary pancreatic duct stenting is widely used, but its effectiveness depends mainly on ductal continuity, leak location, successful stent placement across the ductal disruption, and the presence of disconnected pancreatic duct syndrome or associated collections. When ductal continuity is lost, the leak cannot be bridged, or mature collections and surgically altered anatomy are present, ERCP alone may be insufficient. In these situations, endoscopic ultrasound (EUS)-guided transmural drainage, EUS-guided pancreatic duct drainage, rendezvous techniques, fistula internalization, and combined approaches may provide alternative or complementary routes for internal drainage. This minireview summarizes current endoscopic strategies for pancreatic fistula and proposes an endoscopy-oriented classification framework to guide treatment selection.
Core Tip: Pancreatic fistula should be managed according to pancreatic duct anatomy and endoscopic feasibility. Endoscopic retrograde cholangiopancreatography with transpapillary pancreatic duct stenting is useful when ductal continuity is preserved and the ductal disruption can be bridged. When ductal continuity is lost or complex collections and surgically altered anatomy are present, endoscopic ultrasound-guided approaches may provide internal drainage. This minireview proposes an endoscopy-oriented classification framework to guide treatment selection.
