Various Modalities Accurate in Diagnosing a Disrupted or Disconnected Pancreatic Duct in Acute Pancreatitis: A Systematic Review

Abstract

Background Severe pancreatitis may result in a disrupted pancreatic duct, which is associated with a complicated clinical course. Diagnosis of a disrupted pancreatic duct is not standardized in clinical practice or international guidelines. We performed a systematic review of the literature on imaging modalities for diagnosing a disrupted pancreatic duct in patients with acute pancreatitis. Methods A systematic search was performed in PubMed, Embase and Cochrane library databases to identify all studies evaluating diagnostic modalities for the diagnosis of a disrupted pancreatic duct in acute pancreatitis. All data regarding diagnostic accuracy were extracted. Results We included 8 studies, evaluating five different diagnostic modalities in 142 patients with severe acute pancreatitis. Study quality was assessed, with proportionally divided high and low risk of bias and low applicability concerns in 75% of the studies. A sensitivity of 100% was reported for endoscopic ultrasound and endoscopic retrograde cholangiopancreatography. The sensitivity of magnetic resonance cholangiopancreatography with or without secretin was 83%. A sensitivity of 92% was demonstrated for a combined cohort of secretin-magnetic resonance cholangiopancreatography and magnetic resonance cholangiopancreatography. A sensitivity of 100% and specificity of 50% was found for amylase measurements in drain fluid compared with ERCP. Conclusions This review suggests that various diagnostic modalities are accurate in diagnosing a disrupted pancreatic duct in patients with acute pancreatitis. Amylase measurement in drain fluid should be standardized. Given the invasive nature of other modalities, secretin-magnetic resonance cholangiopancreatography or magnetic resonance cholangiopancreatography would be recommended as first diagnostic modality. Further prospective studies, however, are needed. Electronic supplementary material The online version of this article (10.1007/s10620-020-06413-0) contains supplementary material, which is available to authorized users.

Diagnosis and treatment of pancreatic duct disruption or disconnection: an international expert survey and case vignette study

“…Questions were based on the results of two systematic reviews and the preliminary results of an (unpublished) prospective observational cohort study of the Dutch Pancreatitis Study Group. [9][10][11] Figure 1 The case vignettes: clinical scenarios and imaging findings…”

Diagnosis and Treatment of Pancreatic Duct Disruption or Disconnection: An International Expert Survey and Case Vignette Study

“…Questions were based on the results of two systematic reviews and the preliminary results of an (unpublished) prospective observational cohort study of the Dutch Pancreatitis Study Group. [9][10][11]…”

Diagnosing Disconnected Pancreatic Duct Syndrome: Many Disconnects, Few Answers

“…In the preceding context, there are not many studies on the diagnostic accuracy of imaging modalities for the detection of DPD. In this issue of Digestive Diseases and Sciences, Timmerhuis et al [10] present a meticulous systematic review evaluating several diagnostic methods for diagnosing a disrupted or disconnected pancreatic duct in patients with moderate to severe AP. They included eight studies, evaluating five different diagnostic modalities in 142 patients.…”

“…Strengths of this systematic review [10] include punctilious conception and execution. Granted, this is currently the only literature available, the number of relevant patients was relatively low, the majority of conclusions were built on one or two studies per modality, and only about half of the analyzed studies looked into the diagnostic accuracy as their target endpoint.…”

“…Regarding CECT, Timmerhuis et al [10] analyzed two studies with one demonstrating a sensitivity of 0% [9]. When examined in detail, it concerned CT images of 26 patients with surgically confirmed DPD that were viewed retrospectively for features of DPD.…”