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Endoscopy 2021; 53(06): 603-610
DOI: 10.1055/a-1213-1489
Original article

Impact of disconnected pancreatic duct syndrome on endoscopic ultrasound-guided drainage of pancreatic fluid collections

Lillian Wang
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Sherif Elhanafi
2   Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
,
Andrew C. Storm
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Mark D. Topazian
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Shounak Majumder
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Barham K. Abu Dayyeh
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Michael J. Levy
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Bret T. Petersen
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
John A. Martin
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Suresh T. Chari
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Santhi S. Vege
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
,
Vinay Chandrasekhara
1   Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
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Author commentary on Lillian Wang et al.Endoscopy 2021; 53(06): v26-v26
DOI: 10.1055/a-1263-2498

Abstract

Background Endoscopic intervention for pancreatic fluid collections (PFCs) with disconnected pancreatic duct syndrome (DPDS) has been associated with failures and increased need for additional endoscopic and non-endoscopic interventions. The primary aim of this study was to determine the outcomes of endoscopic ultrasound (EUS)-guided transmural drainage of PFCs in patients with DPDS.

Methods In patients undergoing EUS-guided drainage of PFCs from January 2013 to January 2018, demographic profiles, procedural indications and details, adverse events, outcomes, and subsequent interventions were retrospectively collected. Overall treatment success was determined by PFC resolution on follow-up imaging or stent removal without recurrence.

Results EUS-guided drainage of PFCs was performed in 141 patients. DPDS was present in 57 of them (40 %) and walled-off necrosis was the most frequent type of PFC (55 %). DPDS was not associated with lower clinical success, increased number of repeat interventions, or increased time to PFC resolution. Patients with DPDS were more likely to be treated with permanent transmural plastic double-pigtail stents (odds ratio [OR] 6.4; 95 % confidence interval [CI] 2.5 – 16.5; P < 0.001). However, when stents were removed, DPDS was associated with increased PFC recurrence after stent removal (OR 8.0; 95 %CI 1.2 – 381.8; P = 0.04).

Conclusions DPDS frequently occurs in patients with PFCs but does not negatively impact successful resolution. DPDS is associated with increased PFC recurrence after stent removal.



Publication History

Received: 08 November 2019

Accepted: 06 July 2020

Accepted Manuscript online:
06 July 2020

Article published online:
04 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
    CrossrefPubMedGoogle Scholar
  • 2 Nadkarni NA, Kotwal V, Sarr MG. et al. Disconnected pancreatic duct syndrome: endoscopic stent or surgeon's knife?. Pancreas 2015; 44: 16-22
    CrossrefPubMedGoogle Scholar
  • 3 Lawrence C, Howell DA, Stefan AM. et al. Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of long-term follow-up. Gastrointest Endosc 2008; 67: 673-679
    CrossrefPubMedGoogle Scholar
  • 4 Nealon WH, Bhutani M, Riall TS. et al. A unifying concept: pancreatic ductal anatomy both predicts and determines the major complications resulting from pancreatitis. J Am Coll Surg 2009; 208: 790-799; discussion 799-801
    CrossrefPubMedGoogle Scholar
  • 5 Varadarajulu S, Lopes TL, Wilcox CM. et al. EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc 2008; 68: 649-655
    CrossrefPubMedGoogle Scholar
  • 6 Goyal J, Ramesh J. Endoscopic management of peripancreatic fluid collections. Frontline Gastroenterol 2015; 6: 199-207
    CrossrefPubMedGoogle Scholar
  • 7 Varadarajulu S, Christein JD, Tamhane A. et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008; 68: 1102-1111
    CrossrefPubMedGoogle Scholar
  • 8 Varadarajulu S, Noone TC, Tutuian R. et al. Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc 2005; 61: 568-575
    CrossrefPubMedGoogle Scholar
  • 9 Tellez-Avina FI, Casasola-Sanchez LE, Ramirez-Luna MA. et al. Permanent indwelling transmural stents for endoscopic treatment of patients with disconnected pancreatic duct syndrome: long-term results. J Clin Gastroenterol 2018; 52: 85-90
    CrossrefPubMedGoogle Scholar
  • 10 Yang D, Amin S, Gonzalez S. et al. Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study. Gastrointest Endosc 2016; 83: 720-729
    CrossrefPubMedGoogle Scholar
  • 11 Bang JY, Wilcox CM, Navaneethan U. et al. Impact of disconnected pancreatic duct syndrome on the endoscopic management of pancreatic fluid collections. Ann Surg 2018; 267: 561-568
    CrossrefPubMedGoogle Scholar
  • 12 Mussetto A, Fugazza A, Fuccio L. et al. Current uses and outcomes of lumen-apposing metal stents. Ann Gastroenterol 2018; 31: 535-540
    Google Scholar
  • 13 Han D, Inamdar S, Lee CW. et al. Lumen apposing metal stents (LAMSs) for drainage of pancreatic and gallbladder collections: a meta-analysis. J Clin Gastroenterol 2018; 52: 835-844
    CrossrefPubMedGoogle Scholar
  • 14 Shah RJ, Shah JN, Waxman I. et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol 2015; 13: 747-752
    CrossrefPubMedGoogle Scholar
  • 15 Topazian M. Endoscopic ultrasound-guided drainage of pancreatic fluid collections (with video). Clin Endosc 2012; 45: 337-340
    CrossrefPubMedGoogle Scholar
  • 16 Varadarajulu S, Wilcox CM. Endoscopic placement of permanent indwelling transmural stents in disconnected pancreatic duct syndrome: does benefit outweigh the risks?. Gastrointest Endosc 2011; 74: 1408-1412
    CrossrefPubMedGoogle Scholar
  • 17 Deviere J, Bueso H, Baize M. et al. Complete disruption of the main pancreatic duct: endoscopic management. Gastrointest Endosc 1995; 42: 445-451
    CrossrefPubMedGoogle Scholar
  • 18 Arvanitakis M, Delhaye M, Bali MA. et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 2007; 65: 609-619
    CrossrefPubMedGoogle Scholar
  • 19 Rana SS, Bhasin DK, Sharma R. et al. Factors determining recurrence of fluid collections following migration of intended long term transmural stents in patients with walled off pancreatic necrosis and disconnected pancreatic duct syndrome. Endosc Ultrasound 2015; 4: 208-212
    CrossrefPubMedGoogle Scholar
  • 20 Abu Dayyeh BK, Mukewar S, Majumder S. et al. Large-caliber metal stents versus plastic stents for the management of pancreatic walled-off necrosis. Gastrointest Endosc 2018; 87: 141-149
    CrossrefPubMedGoogle Scholar
  • 21 Park DH, Lee SS, Moon SH. et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 2009; 41: 842-848
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Bang JY, Navaneethan U, Hasan MK. et al. EUS correlates of disconnected pancreatic duct syndrome in walled-off necrosis. Endosc Int Open 2016; 4: E883-E889
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Kamal A, Singh VK, Akshintala VS. et al. CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012. Abdom Imaging 2015; 40: 1608-1616
    CrossrefPubMedGoogle Scholar
  • 24 Drake LM, Anis M, Lawrence C. Accuracy of magnetic resonance cholangiopancreatography in identifying pancreatic duct disruption. J Clin Gastroenterol 2012; 46: 696-699
    CrossrefPubMedGoogle Scholar