Disconnected pancreatic duct syndrome: Updated review on clinical implications and management

Verma, Suhang; Rana, Surinder Singh

doi:10.1016/j.pan.2020.07.402

Cited by 65 publications

(78 citation statements)

References 54 publications

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“…Newly developed cautery enhanced lumen-apposing metal stents (EC-LAMSs) such as Hot Axios stent, Boston Scientific, Natick, MA, USA and Hot-Spaxus (Taewoong Medical Co, Gimpo, Korea) have improved the results of endoscopic drainage of pancreatic fluid collections with high technical and clinical success [20]. A recent meta-analysis assessing Pancreatic duct disruption is an important consequence of acute necrotizing pancreatitis and has been reported variably in 16-84% patients with acute necrotizing pancreatitis or WON [22,23]. The duct disruption leading on to disconnected pancreatic duct syndrome has a significant negative impact on the outcomes of endoscopic transmural drainage of WON.…”

Section: Discussionmentioning

confidence: 99%

A New Entity of Walled off Extra Pancreatic Necrosis is Associated with Better Outcomes Following Endoscopic Transmural Drainage

Rana

Bush

Kang

et al. 2022

JGLD

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Background and Aims: Previous studies have shown that patients with extra-pancreatic necrosis (EPN) alone are associated with better outcomes than patients with pancreatic necrosis (PN) in acute pancreatitis (AP). The natural history and drainage outcome of pancreatic collections resulting from PN vs. EPN has not been studied. Methods: Clinical records of a prospectively maintained cohort of AP patients who underwent endoscopic drainage of walled of necrosis (WON) were reviewed. Computed tomography (CT) done on day 4 to 7 of illness was reviewed to identify EPN alone (Group 1) or PN with or without EPN (Group 2). Group 1 and 2 were compared for WON characteristics, as well as outcome and adverse effects of endoscopic drainage. Results: Seventy-one patients in Group 2 (57 males; mean age 38.6±11.5 years) were compared with sixteen patients in Group 1 (12 males; mean age 34.5±10.8 years). WON developing in Group 2 were significantly larger (11.7±2.8 cm vs. 9.5±2.03 cm) with higher solid necrotic debris (30.4±9.8% vs. 13.7±7.2%). Endoscopic transmural drainage of WON associated with PN required a greater number of direct endoscopic necrosectomy (DEN) sessions along with a longer time for resolution. The time taken for resolution correlated with size (r=0.629, p <0.01) and solid debris content (r=0.647, p<0.01), which were significantly higher in the PN group. Conclusions: This new entity of walled of extra pancreatic necrosis alone has lesser solid necrotic debris and its endoscopic drainage is associated with better outcomes as compared to patients with walled off pancreatic necrosis.

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Section: Discussionmentioning

confidence: 99%

A New Entity of Walled off Extra Pancreatic Necrosis is Associated with Better Outcomes Following Endoscopic Transmural Drainage

Rana

Bush

Kang

et al. 2022

JGLD

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“…In our study, 3 patients had an incompletely formed wall and endoscopic drainage was done earlier than 4 weeks in 8 (61%) patients. Also, 84% patients had complete MPD disruption and leaving transmural stents in situ in these patients for an indefinite period probably keeps the iatrogenic transmural tract patent and thus reduces the risk of recurrence of PFC due to DPD syndrome [ 16 ]. None of our patients with complete duct disruption and indwelling transmural stent had either recurrence of PFC or abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic ultrasound (EUS)-guided transmural drainage is a safe and effective minimally invasive treatment option for pseudocysts and walled off necrosis [ 14 , 15 ]. Also, it is safe and effective in patients with PFC associated with complete MPD disruption with the strategy of maintaining the patency of iatrogenic fistula by leaving transmural stents in situ for an indefinite period, associated with an excellent long-term outcome [ 16 ]. However, experience with EUS-guided transmural drainage of post-traumatic PFC is limited to case reports [ 5 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided transmural drainage of post-traumatic pancreatic fluid collections

Rana¹,

Sharma²,

Dhalaria³

et al. 2021

aog

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Background Pancreatic injury is an uncommon consequence of abdominal trauma, and surgery has been the conventional treatment. The role and timing of endoscopic ultrasound (EUS)-guided treatment of the consequences of traumatic pancreatic injury is unclear. Our study evaluated the safety and efficacy of EUS-guided transmural drainage of post-traumatic pancreatic fluid collections (PFC). Methods A retrospective analysis of 13 patients (mean age 20.2±4.4 years; 12 males) with post-traumatic PFC treated with EUS-guided transmural drainage over the last 10 years was performed. Patient demographics, imaging findings, size of PFC, details of endoscopic transmural drainage procedure, outcome details, as well complications were retrieved from our database. Results The patients underwent drainage at 26.8±7.4 days after abdominal trauma, and the mean size of PFC was 11.8±3.2 cm with 2 patients having multiple fluid collections. Ten patients had PFC with a well-formed wall and 3 patients had an incompletely formed wall. Endoscopic drainage was technically successful in all 13 patients and 11 patients underwent transmural drainage with multiple plastic stents whereas 2 patients were treated with lumen apposing metal stents. The PFC resolved in all patients over a mean period of 2.7±0.4 weeks. One patient developed gastrointestinal bleeding 6 days after the procedure, successfully treated with angio-embolization. Conclusion EUS-guided transmural drainage of post-traumatic PFC is safe and effective and can be safely performed at an early phase (<4 weeks) after pancreatic trauma.

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“…Often multiple imaging modalities are required for accurate diagnosis, which in turn leads to delays in diagnosis, increased morbidity, and increased costs. [53][54][55] Diagnostic criteria for DPDS include: necrosis of ≥2 cm of pancreatic parenchyma, viable pancreatic tissue distal to the area of necrosis, and extravasation of contrast when injected into the main pancreatic duct during ERCP. [56] Once DPDS is diagnosed, choice of intervention is dependent on the patient's clinical condition and the phase of disease.…”

Section: Disconnected Pancreatic Duct Syndromementioning

confidence: 99%

Surgical Management of Necrotizing Pancreatitis

Thompson¹,

Bolourani²,

Giangola³

2022

Recent Advances in Pancreatitis

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Pancreatic necrosis is a highly morbid condition. It is most commonly associated with severe, acute pancreatitis, but can also be caused by trauma or chronic pancreatitis. Once diagnosed, management of pancreatic necrosis begins with supportive care, with an emphasis on early, and preferably, enteral nutrition. Intervention for necrosis, sterile or infected, is dictated by patient symptoms and response to conservative management. When possible, intervention should be delayed to allow the necrotic collection to form a capsule. First-line treatment for necrosis is with percutaneous drainage or endoscopic, transmural drainage. These strategies can be effective as monotherapy, but the need for repeated interventions, or for progression to more invasive interventions, is not uncommon. Necrosectomy may be performed using a previously established drainage tract, as in percutaneous endoscopic necrosectomy (PEN), video-assisted retroperitoneal debridement (VARD), and direct endoscopic necrosectomy (DEN). Although outcomes for these minimally-invasive techniques are better than for traditional necrosectomy, both laparoscopic and open techniques remain important for patients with extensive disease that cannot otherwise be adequately treated. This is especially true when pancreatic necrosis is complicated by disconnected pancreatic duct syndrome (DPDS), where necrosectomy remains standard of care.

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Disconnected pancreatic duct syndrome: Updated review on clinical implications and management

Cited by 65 publications

References 54 publications

A New Entity of Walled off Extra Pancreatic Necrosis is Associated with Better Outcomes Following Endoscopic Transmural Drainage

A New Entity of Walled off Extra Pancreatic Necrosis is Associated with Better Outcomes Following Endoscopic Transmural Drainage

Endoscopic ultrasound-guided transmural drainage of post-traumatic pancreatic fluid collections

Surgical Management of Necrotizing Pancreatitis

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