Disconnected pancreatic duct syndrome in patients with necrotizing pancreatitis

Vaněk, Petr; Urban, Ondřej; Trikudanathan, Guru; Freeman, Martin L.

doi:10.1016/j.sopen.2022.10.009

Cited by 17 publications

(11 citation statements)

References 64 publications

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“…There is an ongoing discussion of the efficiency of transpapillary and transmural stenting in patients with disconnected pancreatic duct syndrome ( 14 ). There are currently no universally accepted guidelines for the diagnosis and treatment of disconnected pancreatic duct syndrome, and because the condition is underrecognized, the diagnosis is often delayed ( 15 ). However, pancreatic stenting is now a more widely performed procedure in cases of intraductal hypertension, bypass obstructing stones, restoring lumen patency in cases with dominant, symptomatic strictures, and so on ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transpapillary stent placement in patients with necrotizing pancreatitis and disconnected main pancreatic duct syndrome

Shabunin,

Bagatelia,

Bedin

et al. 2023

Front. Surg.

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IntroductionPancreatic necrosis is one of the most severe acute abdominal conditions, accounting for 15%–20% of all patients with acute pancreatitis and characterized by significant rates of postoperative complications and mortality. Patients with pancreatic necrosis, in which pathological changes are localized in the proximal pancreas and retroperitoneal space, deserve special attention. This form of the disease includes patients with disconnected main pancreatic duct (MPD) syndrome who have a difficult prognosis.AimThe aim of the study was an improvement of treatment results in patients with necrotizing pancreatitis and signs of the dissociation of the pancreas duct system using the endoscopic transpapillary stent placement method.Material and methodsThis study was a retrospective cohort study. There were 32 patients with acute necrotizing pancreatitis who were managed using the endoscopic transpapillary stent placement method between 2019 and 2021. Disconnected MPD syndrome was diagnosed in all 32 patients. In total, 26 patients were admitted to hospital in the first 72 h, while 6 patients were admitted after 72 h. We diagnosed the necrotizing process located in the proximal and central areas of the pancreas and peripancreatic space in all these patients (“model III”).ResultsPositive results related to transpapillary stent placement were noted in 24 (75%) patients (first cohort). A total of 20 patients from this group were admitted to hospital in the first 48 h, and 4 patients were admitted later than 72 h from the onset of disease. Moreover, 8 patients (25%; second cohort) failed to succeed in transpapillary stent placement. Complications in the first cohort occurred in 3 (12.5%) patients: dislocation of the stent into the duodenum occurred in 1 patient, and bleeding after papillosphincterotomy took place in 2 patients. Meanwhile, infected necrotized pancreatitis developed in 5 patients, and 1 patient (5%) died. Complications among the second cohort occurred in 2 (25%) patients: erosive bleeding (after debridement). Infected necrotized pancreatitis developed in 4 patients, and 2 patients (25%) died.ConclusionsEndoscopic transpapillary stent placement is an effective minimally invasive approach in the management of patients with necrotizing pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Endoscopic transpapillary stent placement in patients with necrotizing pancreatitis and disconnected main pancreatic duct syndrome

Shabunin,

Bagatelia,

Bedin

et al. 2023

Front. Surg.

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“…Definition : Disconnected duct syndrome (DDS) has been defined previously [ 22 , 23 ]. Briefly, DDS is a condition when cross-sectional imaging (CT or MR) or ERCP demonstrates disruption of the main pancreatic duct between segments of viable secreting pancreatic tissue.…”

Section: Methodsmentioning

confidence: 99%

“…Rationale : Disconnected duct syndrome is associated with prolonged hospitalization, longer duration of percutaneous drainage, pancreatic fistula formation, and increased morbidity and mortality [ 13 , 14 , 23 ]. Intervention focuses on decreasing the risk of pancreatic fistula formation with preferential use of endoscopic drainage and/or internal surgical drainage (e.g.…”

Section: Methodsmentioning

confidence: 99%

A location-based anatomic classification system for acute pancreatic fluid collections: Roadmap for optimal intervention in the step-up era

Clark,

Ray,

Pawa

et al. 2024

Surgery Open Science

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“…Disconnected pancreatic duct syndrome (DPDS) occurs when complete main pancreatic duct disruption isolates upstream viable pancreatic tissue, resulting in PFC formation ( 6 , 7 ). DPDS has been shown to increase PFC recurrence rates, hospital length of stay, and morbidity while decreasing the likelihood of successful percutaneous drainage ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of long-term transmural drainage with double pigtail stents in disconnected pancreatic duct syndrome

Koutlas,

Bentley,

Dorrell

et al. 2024

Transl Gastroenterol Hepatol

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Background Disconnected pancreatic duct syndrome (DPDS) is a common cause of recurrent pancreatic fluid collections (PFCs), often requiring repeat drainage. Following initial drainage with lumen apposing metal stents (LAMS), replacement with transmural double pigtail stents (DPS) has been shown to be a viable drainage modality mitigating the risk of recurrence. The sparsity of literature on the consequences of this strategy requires further investigation. We analyze our outcomes of long-term transmural drainage with DPS in patients with DPDS and assess the safety and efficacy of this technique. Methods This retrospective review of a prospectively maintained database from November 2015–May 2022 included all patients with DPDS who underwent removal of LAMS and replacement with long-term transmural DPS. Patient demographics, collection characteristics, drainage technique and outcomes, as well as follow-up data was collected and analyzed using descriptive statistics. Results There were 139 patients who underwent endoscopic drainage of PFCs with LAMS during the study period. Seventy-eight patients [walled-off necrosis (n=65) and pseudocysts (n=13)] were found to have DPDS. Of these, 44 patients underwent successful LAMS removal followed by replacement with DPS and were included in the analysis. The median age was 57 years and 14 (32%) were female. The median stent dwell time was 394 days [interquartile range (IQR) 245, 853 days]. Spontaneous stent migration was seen in seven patients (16%), one of whom developed a PFC recurrence which was managed conservatively. The second recurrence was seen in a patient with indwelling DPS which did not require further intervention. There were no locoregional adverse events secondary to long-term indwelling DPS. Among the 28 patients who were followed for a year, three patients developed new-onset diabetes, and chronic pancreatitis (CP) changes in the disconnected segment were seen in eight patients, five of whom required pancreatic enzyme supplementation. Conclusions Placement of long-term transmural DPS is an effective modality for preventing collection re-accumulation with a favorable safety profile. Randomized prospective studies are essential to investigate the optimal removal timing of indwelling stents to prevent loco-regional complications. Given the realized risk of CP in the disconnected pancreas, follow-up cross sectional imaging may help guide further therapy.

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Disconnected pancreatic duct syndrome in patients with necrotizing pancreatitis

Cited by 17 publications

References 64 publications

Endoscopic transpapillary stent placement in patients with necrotizing pancreatitis and disconnected main pancreatic duct syndrome

Endoscopic transpapillary stent placement in patients with necrotizing pancreatitis and disconnected main pancreatic duct syndrome

A location-based anatomic classification system for acute pancreatic fluid collections: Roadmap for optimal intervention in the step-up era

Clinical outcomes of long-term transmural drainage with double pigtail stents in disconnected pancreatic duct syndrome

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