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Manifestations of leaks include pseudocysts, pancreatic ascites, high amylase pleural effusions, disconnected duct syndrome, and internal and external pancreatic fistulas. Patient presentations are highly variable and range from asymptomatic pancreatic cysts to patients with severe abdominal pain and sepsis from infected fluid collections. The diagnosis can often be made by high\u2010quality cross\u2010sectional imaging or during endoscopic retrograde cholangiopancreatography (<jats:styled-content style=\"fixed-case\">ERCP<\/jats:styled-content>). Because of their complexity, pancreatic leak patients are best managed by a multidisciplinary team comprised of therapeutic endoscopists, interventional radiologists, and surgeons in the field of pancreatic interventions. Minor leaks will often resolve with conservative management while severe leaks will frequently require interventions. Endoscopic treatments for pancreatic duct leaks have replaced surgical interventions in many situations.<\/jats:p><jats:p>Interventional radiologists also have the ability to offer therapeutic interventions for many leak patients. The mainstay of endotherapy for pancreatic leaks is transpapillary pancreatic duct stenting with a stent that bridges the leak if possible, but varies based on the manifestation and clinical presentation. Fluid collections that result from leaks, such as pseudocysts, can often be treated by endoscopic transluminal drainage with or without endoscopic ultrasound or by percutaneous drainage. Endoscopic interventions have been shown to be effective and have an acceptable complication rate.<\/jats:p>","DOI":"10.1111\/jgh.12574","type":"journal-article","created":{"date-parts":[[2014,3,20]],"date-time":"2014-03-20T11:57:08Z","timestamp":1395316628000},"page":"1360-1370","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":114,"title":["Management of pancreatic ductal leaks and fistulae"],"prefix":"10.1111","volume":"29","author":[{"given":"Michael","family":"Larsen","sequence":"first","affiliation":[{"name":"Digestive Disease Institute Virginia Mason Medical Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Kozarek","sequence":"additional","affiliation":[{"name":"Digestive Disease Institute Virginia Mason Medical Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,7,15]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(01)00606-7"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2007.11.041"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102007\u2010967043"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2007.05.013"},{"key":"e_1_2_14_6_1","first-page":"1175","volume-title":"Textbook of Clinical Gastroenterology","author":"Kozarek RA","year":"1998"},{"key":"e_1_2_14_7_1","first-page":"39","article-title":"Endoscopic therapy of complete and partial pancreatic duct disruptions","volume":"8","author":"Kozarek RA","year":"1998","journal-title":"Gastrointest. 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