Multimodality endoscopic treatment of pancreatic duct disruption with stenting and pseudocyst drainage: How efficacious is it?

Charles W. Shrode, Patrick MacDonough, Monica Gaidhane, Patrick G. Northup, Bryan Sauer, Jennifer Ku, Kristi Ellen, Vanessa M. Shami, Michel Kahaleh

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Background: Few studies have described the role of multimodality therapy and the complexity of endoscopic management of pancreatic duct disruption. Our study aim was to analyse and confirm factors associated with the resolution of pancreatic duct disruption. Methods: Over 6 years, retrospective data on patients with pancreatic duct disruption managed endoscopically were retrieved. Success was defined as resolution of the pancreatic duct disruption at 12 months. Logistic regression analysis was performed to determine factors associated with resolution. Results: 113 patients (78 male) with a mean age 51.3 year were included. Resolution of the pancreatic duct leak occurred in 80 cases (70.2%). 72 cases received transpapillary pancreatic duct stents, with 51 demonstrating resolution of pancreatic duct leak (71%) cystenterostomy was performed in 68 patients with 51 resolved (75%). In partial duct disruptions, pancreatic duct stenting combined with endoscopic drainage of fluid collections resulted in an increased rate of resolution (80%) compared to complete disruptions treated in a similar manner (57%). In complete pancreatic ductal disruptions, transpapillary pancreatic duct stenting had no additional benefit (9/17, 52.9%) compared to cystenterostomy or percutaneous drainage alone (24/34, 70.6%; P= 0.61). Conclusion: Pancreatic duct disruptions require multimodality treatment, addressing not only the integrity of the pancreatic duct but also any fluid collections associated. Partial ductal disruption should be managed by a bridging stent.

Original languageEnglish (US)
Pages (from-to)129-133
Number of pages5
JournalDigestive and Liver Disease
Volume45
Issue number2
DOIs
StatePublished - Feb 1 2013
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Keywords

  • Endoscopy
  • Pancreatic duct disruption
  • Pancreatic duct leak
  • Pseudocyst drainage
  • Stent

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