To assess the effectiveness of various endoscopic techniques in the treatment of patients with post-inflammatory pancreatic fistulas.

A prospective analysis of endoscopic treatment outcomes of all patients with pancreatic fistulas secondary to inflammatory pancreatic diseases between 2018 and 2025 at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toruń.

Post-inflammatory pancreatic fistulas were diagnosed in 56 patients (51 with internal pancreatic fistulas, and 5 with external, i.e. pancreatico-cutaneous fistulas). Among internal fistulas, the most common abnormal connection was between the pancreatic ducts and the pleural cavity—pancreaticopleural fistulas were diagnosed in 33 patients, followed by pancreaticoperitoneal fistulas in 14 patients, pancreaticointestinal fistulas in 2 patients, and pancreatico-biliary fistulas in 2 patients. Chronic pancreatitis was identified in 33/56 (58.93%) patients. Endoscopic retrograde pancreatography with endoscopic sphincterotomy and main pancreatic duct stenting was performed in 47/56 (83.93%) patients. In 9/56 (16.07%) patients, due to lack of anatomical transpapillary access to the main pancreatic duct, transmural drainage of the fistula tract under EUS guidance was performed. Clinical success was achieved in 51/56 (91.07%) patients. The total duration of endotherapy averaged 513 (91–1399) days. Long-term success of endoscopic treatment was achieved in 48/56 (85.71%) patients.

Endoscopic treatment seems an effective therapeutic method for post-inflammatory pancreatic fistulas. Passive transpapillary drainage (main pancreatic duct stenting) remains the preferred treatment method. When anatomical transpapillary drainage is not feasible, EUS-guided transmural drainage of the fistula tract remains the alternative. In patients with pancreatic fluid collections complicated by the presence of a pancreatic fistula, decompression of the collection via endoscopic drainage leads to fistula closure.