Treatment of disrupted and disconnected pancreatic duct in necrotizing pancreatitis: A systematic review and meta-analysis

Dijk, Sven M. van; Timmerhuis, Hester C.; Verdonk, Robert C.; Reijnders, Evelien; Bruno, Marco J.; Fockens, Paul; Voermans, Rogier P.; Besselink, Marc G.; Santvoort, Hjalmar C. van

doi:10.1016/j.pan.2019.08.006

Cited by 37 publications

(34 citation statements)

References 46 publications

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“…A recent review reported higher success rates for transpapillary drainage (81.0%) than those observed in the current review (58.5%), a potential consequence of including the less severe partial duct disruption [27,32,43], resulting in comparable outcomes for transpapillary and transmural endoscopic approaches. That study also found comparable success between endoscopic and surgical management and so recommended a step-up model to offer surgical treatment of DPDS following endoscopic failure [7]. In this study cohort of patients diagnosed with DPDS, we found transmural drainage to be superior to transpapillary drainage but comparable to surgical management.…”

Section: Discussionsupporting

confidence: 65%

“…Selecting the optimal treatment remains challenging as there are few quantitative comparative studies on which to base the decision. A previous review of DPDS found no differences among various endoscopic drainage and surgery techniques [7]. However, that analysis was hampered by heterogeneity in its study populations speci cally due to the inclusion of patients with partial duct disruption [7].…”

Section: Introductionmentioning

confidence: 99%

“…A previous review of DPDS found no differences among various endoscopic drainage and surgery techniques [7]. However, that analysis was hampered by heterogeneity in its study populations speci cally due to the inclusion of patients with partial duct disruption [7]. This potentially skewed the results to favour endoscopic drainage, especially transpapillary drainage, because partial duct disruptions have signi cantly better outcomes when treated endoscopically with transpapillary stenting or drainage and were generally not treated with surgery.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Lastly, exposure of 3T3-L1 adipocytes to linoleic acid (LA), previously shown to be present at approximately 2 mM in acute pancreatitis collections, also injured adipocytes, leading to entry of PNLIP into the cells (Supplemental Figure 4D). Thus, pancreatic enzymes including lipases, which may leak from a disrupted duct (57,58) or basolaterally during human (44)(45)(46) and experimental pancreatitis (47)(48)(49), can enter the surrounding visceral adipocytes in multiple ways and cause organ failure. Therefore, we went on to identify the relative contribution of pancreatic lipases versus ATGL to acute pancreatitisassociated fat necrosis, and consequent pancreatic acinar necrosis, the source of pancreatic lipase leakage.…”

Section: Resultsmentioning

confidence: 99%

Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation

Oliveira¹,

Khatua²,

Noel³

et al. 2020

Journal of Clinical Investigation

105

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“…A certain diagnosis of DPDS requires the presence of three criteria: a) necrosis of at least 2 cm length of pancreas, b) viable pancreatic tissue upstream from the site of necrosis (ie, toward the pancreatic tail), and c) extravasation of contrast material-injected from the MPD at pancreatography [6]. Although surgery was historically recommended for all DPDS, endoscopic techniques have evolved from endoscopic transpapillary stenting and drainage through to endoscopic ultrasound and endoscopic transmural drainage of DPDS [4,[7][8][9]. 'Endoscopic drainage' for DPDS is now categorized as transpapillary drainage, transmural drainage, or a combination of both techniques.…”

mentioning

confidence: 99%

Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

Background Disconnected 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 aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The 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. Results Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). 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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Treatment of disrupted and disconnected pancreatic duct in necrotizing pancreatitis: A systematic review and meta-analysis

Cited by 37 publications

References 46 publications

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

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

Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation

Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis

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