Impact of Disconnected Pancreatic Duct Syndrome on the Endoscopic Management of Pancreatic Fluid Collections

Bang, Ji Young; Cm, Wilcox; Navaneethan, Udayakumar; Hasan, Muhammad; Peter, Shajan; Christein, John D.; Hawes, Robert H.; Varadarajulu, Shyam

doi:10.1097/sla.0000000000002082

Cited by 117 publications

(164 citation statements)

References 25 publications

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“…However, if the stents were removed within a 3‐week time frame there was no difference in the rate of bleeding between cohorts . More than 70% of patients with WON have disconnected pancreatic duct syndrome; given the high rate of PFC recurrence in this patient cohort, it is important that an indwelling stent remain in situ to facilitate drainage of the upstream gland . As LAMS cannot be left indefinitely in situ , they must be exchanged for plastic stents in patients with disconnected ducts.…”

Section: Current Clinical Applicationsmentioning

confidence: 99%

“…3 More than 70% of patients with WON have disconnected pancreatic duct syndrome; given the high rate of PFC recurrence in this patient cohort, it is important that an indwelling stent remain in situ to facilitate drainage of the upstream gland. 6 As LAMS cannot be left indefinitely in situ, they must be exchanged for plastic stents in patients with disconnected ducts. Although LAMS are more expensive than plastic stents for the treatment of pseudocysts, 7,8 given the need for multiple interventions and prolonged hospital stay in patients with WON, no difference has been observed in overall treatment costs between stent • Although retrospective studies report a higher clinical success rate for LAMS for the treatment of WON, 9 no such difference was observed in a recent randomized trial.…”

Section: Current Clinical Applicationsmentioning

confidence: 99%

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Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Bang

Varadarajulu

2019

Digestive Endoscopy

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Lumen‐apposing metal stents (LAMS) are integrated in a single‐step delivery platform and can be deployed under endoscopic ultrasound‐guidance for the drainage of intra‐abdominal fluid collections, decompression of obstructed ductal systems, establishment of anastomosis or creation of fistulous tracts between organs that can facilitate further endoscopic interventions if required. A unique feature of LAMS is their ability to approximate the adjoining structures, thereby minimizing the potential for leak and perforation. Consequently, the innovation has advanced our ability to carry out complex therapeutic interventions and obviate the need for high‐risk surgical procedures, particularly in morbid patients. However, a keen awareness of the technical design of LAMS and its implication on treatment effect is important to minimize adverse events and to improve clinical outcomes. This review outlines the technical approach to placement of LAMS, procedural challenges, adverse events, current clinical indications and emerging applications.

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Section: Current Clinical Applicationsmentioning

confidence: 99%

Section: Current Clinical Applicationsmentioning

confidence: 99%

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Bang

Varadarajulu

2019

Digestive Endoscopy

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“…In addition, the presence of disconnected pancreatic duct (DPD) may impact the outcomes of ETD. The requirement of hybrid treatment, re-interventions, recurrences, and rescue surgery appear to be higher in the patients with DPD [21].…”

Section: Endoscopic Drainage Of Pfcsmentioning

confidence: 92%

Endoscopic Management of Pancreatic Fluid Collections: An Update

Nabi¹,

Reddy²

2019

Pancreatitis

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Pancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. PFCs have been categorized according to their content and duration after an episode of pancreatitis. Acute collections (<4 week) and asymptomatic late collections (>4 weeks) can be usually managed conservatively. Late collections including walled off necrosis (WON) and pancreatic pseudocysts (PP) have a well-defined wall. Consequently, it is easier and safer to drain these collections when required. The most common indication to drain PFCs is infection and the available means of drainage include surgical, endoscopic, and percutaneous. Open surgical interventions carry a high risk of morbidity and mortality. Therefore, in the current era, a step up approach is preferred to minimize morbidity over the more aggressive surgical treatments. Endoscopic step-up approach is effective and favored over minimally invasive surgical or percutaneous drainage due to reduced risk of organ failure and external pancreatic fistula. However, the approach to PFCs should be individualized for optimal outcomes. A small subgroup of patients does not respond to endotherapy or percutaneous interventions and requires open surgical debridement. Similarly, not all PFCs are amenable to endoscopic drainage and demand alternative modalities like percutaneous or minimally invasive surgical drainage.

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“…Plastic double pig-tails stents were usually used to maintain patency of the stula. In selected cases, metal stent was deployed and on follow-up procedure removed or replaced with double pig-tail stents for long-term drainage [3,13,14]. Combined-modality drainage was de ned as the combined approach of using transpapillary and transmural drainage.…”

Section: Data Extractionmentioning

confidence: 99%

“…Disconnected pancreatic duct syndrome (DPDS) complicates 30% of patients with acute necrotizing pancreatitis and commonly manifests as persistent pancreatic uid collections (PFC) or external pancreatic stulae (EPF) [1][2][3][4][5]. Pancreatic necrosis involving the main pancreatic duct (MPD) results in the disconnection between the proximal MPD and the distal remnant gland.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

Pandanaboyana

Ratnayake

et al. 2020

Preprint

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BackgroundDisconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aim to review the definitions, clinical presentation, intervention, and outcomes for DPDS. MethodsThe PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.ResultsThirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.2%, 918/964), followed by chronic pancreatitis (3.1%, 30/964). DPDS commonly presented with PFC (77.3%,728/942) and EPF (18.6%, 175/942). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI: 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P=0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

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Impact of Disconnected Pancreatic Duct Syndrome on the Endoscopic Management of Pancreatic Fluid Collections

Abstract: DPDS has a significant effect on endoscopic management of PFCs as more patients required hybrid treatment, reinterventions, and rescue surgery for achieving optimal clinical outcomes.

Cited by 117 publications

References 25 publications

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Endoscopic Management of Pancreatic Fluid Collections: An Update

Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

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