Botox fails to prevent fistula after distal pancreatectomy

Preoperative botulinum toxin injection into the sphincter of Oddi did not reduce clinically relevant fistula after distal pancreatectomy; fistulas were numerically more frequent with injection.

• Among patients who underwent surgery, grade B/C fistula occurred in 28.6% (6/21) with injection versus 15% (3/20) without it (p=0.294).
• The 50-patient randomized trial stopped early for futility. Injection was feasible, with no postprocedure pancreatitis; one patient in the injection group died after fistula-related hemorrhage.

This small pilot does not support adding the procedure for fistula prevention, though it cannot rule out smaller effects.