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

Boxhoorn, Lotte; Timmerhuis, Hester C.; Verdonk, Robert C.; Besselink, Marc G.; Bollen, Thomas L.; Bruno, Marco J.; Elmunzer, B. Joseph; Fockens, Paul; Horvath, Karen D.; Santvoort, Hjalmar C. van; Voermans, Rogier P.; Albert, Jörg; Arvanitakis, Marianna; Badaoui, Abdenor; Barthet, Marc; Biervliet, G. van; Bradley, Edward L.; Boermeester, Marja A.; Büchler, MW; Cappendijk, Vincent C.; Charnley, Richard; Connor, Saxon; Dejong, Cornelis H. C.; Dellinger, Patchen; Dervenis, Christos; Devière, J; Dumonceau, Jean‐Marc; Eijck, Casper van; Fagenholz, Peter J.; Castillo, C. Fernandez-del; Forsmark, Christopher E.; Freeman, Martin L.; French, Jeremy; Goor, Harry van; Haveman, Jan-Willem; Hooft, Jeanin E. van; Hucl, Tomáš; Isaji, Shuji; Jagielski, Mateusz; Karjula, Heikki; Lerch, Markus M.; Lévy, Philippe; Lillemoe, Keith D.; Löhr, Matthias; Mayerle, Julia; Mittal, Anubhav; Morgan, Desiree E.; Moon, Sung–Hoon; Nieuwenhuijs, Vincent B.; Sarr, Michael G.; Seewald, Stefan; Sherman, Stuart; Singh, Vikesh K.; Siriwardena, Ajith K.; Stommel, Martijn W J; Tann, Mark; Téllez-Avina, F.; Timmer, Robin; Traverso, William; Radenković, Dejan; Rana, Surinder Singh; Rebours, Vinciane; Peláez-Luna, Mario; Poley, Jan–Werner; Windsor, John A.; Zaheer, Atif; Zyromski, N.J.

doi:10.1016/j.hpb.2020.11.1148

Cited by 12 publications

(9 citation statements)

References 34 publications

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“…An international survey identified a clinically relevant lack of expert consensus on diagnosing and treating pancreatic duct disruption or disconnection in patients with necrotizing pancreatitis [ 77 ]. However, magnetic resonance imaging/magnetic resonance cholangiopancreatography was the preferred diagnostic modality, while endoscopic transluminal drainage was the preferred intervention for patients with DPDS.…”

Section: Management Of Disconnected Pancreatic Duct Syndrome (Dpds)mentioning

confidence: 99%

Endoscopic management of pancreatic walled-off necrosis

Ramai¹

2023

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Pancreatic walled-off necrosis (WON) is a complication of severe pancreatitis. Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collections. Endoscopy offers a minimally invasive approach when compared to surgical drainage. Today, endoscopists may choose to use self-expanding metal stents, pigtail stents, or lumen-apposing metal stents to facilitate drainage of fluid collections. Current data suggest that all 3 approaches yield similar outcomes. It was previously thought that drainage should be performed 4 weeks from the initial event of pancreatitis, theoretically allowing the capsule to mature. However, current data show that both early (<4 weeks) and standard (≥4 weeks) endoscopic drainage are comparable. Herein, we provide an up-to-date state-of-the-art review of the indications, techniques, innovations, outcomes, and future perspectives following drainage of pancreatic WON.

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Section: Management Of Disconnected Pancreatic Duct Syndrome (Dpds)mentioning

confidence: 99%

Endoscopic management of pancreatic walled-off necrosis

Ramai¹

2023

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“…[ 21 , 27 , 31 , 32 ] In a recent international expert survey involving 56 pancreatologists, most experts agreed that MRCP was the preferred diagnostic modality to evaluate PD integrity, but almost half of them never performed secretin-enhanced MRCP. [ 10 ] Actually, it is a problem beyond neglect that obstacles restricting its wide application, such as limited access to secretin and/or higher costs should be eliminated. [ 10 ]…”

Section: Magnetic Resonancementioning

confidence: 99%

“…[ 2 ] Although endoscopic approach has been established as the first-line treatment for PFC with less invasion and satisfactory outcome,[ 7 8 9 ] there are no standardized guidelines for the treatment of DPDS for the time being. [ 1 , 10 ] The presence of DPDS obviously complicates PFC and the management is currently at the discretion of the treating clinician. Conservative managements, including antibiotics and nutritional supportive therapy, are important for patients with DPDS, especially in the early stage of disease.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of pancreatic fluid collections with disconnected pancreatic duct syndrome

Wang

Song

et al. 2022

Endoscopic Ultrasound

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Disconnected pancreatic duct syndrome (DPDS) is an important and common complication of acute necrotizing pancreatitis. Endoscopic approach has been established as the first-line treatment for pancreatic fluid collections (PFCs) with less invasion and satisfactory outcome. However, the presence of DPDS significantly complicates the management of PFC; besides, there is no standardized treatment for DPDS. The diagnosis of DPDS presents the first step of management, which can be preliminarily established by imaging methods including contrast-enhanced computed tomography, ERCP, magnetic resonance cholangiopancreatography (MRCP), and EUS. Historically, ERCP is considered as the gold standard for the diagnosis of DPDS, and secretin-enhanced MRCP is recommended as an appropriate diagnostic method in existing guidelines. With the development of endoscopic techniques and accessories, the endoscopic approach, mainly including transpapillary and transmural drainage, has been developed as the preferred treatment over percutaneous drainage and surgery for the management of PFC with DPDS. Many studies concerning various endoscopic treatment strategies have been published, especially in the recent 5 years. Nonetheless, existing current literature has reported inconsistent and confusing results. In this article, the latest evidence is summarized to explore the optimal endoscopic management of PFC with DPDS.

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“…Endoscopic treatment of disruption in the continuity of the MPD, and consequently, PFs caused by pancreatitis, involves performing endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and implantation of the prosthesis into the MPD (passive transpapillary drainage) to ensure physiological outflow of pancreatic juice into the duodenum (Jagielski et al, 2017;Jagielski et al, 2018a;Jagielski et al, 2018b;Jagielski et al, 2020;Jagielski and Jackowski, 2021b) The use of endoscopic techniques in the treatment of MPD disruption caused by pancreatitis remains controversial (Boxhoorn et al, 2021). Most of the evidence on the diagnosis and therapy of post-inflammatory PPFs is derived from single case reports (Wee et al, 2017;Ramahi et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…The use of endoscopic techniques in the treatment of MPD disruption caused by pancreatitis remains controversial ( Boxhoorn et al., 2021 ). Most of the evidence on the diagnosis and therapy of post-inflammatory PPFs is derived from single case reports ( Wee et al., 2017 ; Ramahi et al., 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of pancreaticopleural fistulas

Jagielski

Piątkowski

Jackowski

2022

Front. Cell. Infect. Microbiol.

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IntroductionPancreaticopleural fistula (PPF) is a serious complication of acute and chronic pancreatitis.ObjectiveTo evaluate the effectiveness of various endoscopic techniques for the treatment of patients with PPFs.MethodologyProspective analysis of the results of endoscopic treatment of 22 patients with PPF due to pancreatitis was conducted at the Department of General, Gastroenterological, and Oncological Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, between 2018 and 2021.ResultsPPF was diagnosed in 22 patients (21 men and 1 woman; mean age 49.52 [30–67] years) with pancreatitis. In 19/22 (86.36%) patients, PPF communicated with the left pleural cavity and in 3/22 (13.64%) patients with the right pleural cavity. Chronic pancreatitis was diagnosed in 14/22 (63.64%) patients. Symptomatic pancreatic fluid collections were found in 15/22 (68.18%) patients with PPF (pancreatic pseudocyst in 11 and walled-off pancreatic necrosis in four patients). Endoscopic retrograde cholangiopancreatography was performed in 21/22 (95.45%) patients, confirming the diagnosis of PPF. All 21 patients underwent endoscopic sphincterotomy with prosthesis implantation in the main pancreatic duct (passive transpapillary drainage). In 1/22 (4.55%) patients, active transmural/transgastric drainage of the PPF was necessary due to inflammatory infiltration of the peripapillary region, precluding endoscopic pancreatography. Endoscopic transmural drainage was performed in all the 15 patients with pancreatic fluid collection. Clinical success was achieved in 21/22 (95.45%) patients. The mean total time of endotherapy was 191 (range 88–712) days. Long-term success of endoscopic treatment of PPFs during one year follow-up period was achieved in 19/22 (86.36%) patients.ConclusionsEndoscopic treatment is effective for managing post-inflammatory PPFs. The preferred treatment method is passive transpapillary drainage (prosthesis of the main pancreatic duct). If transpapillary drainage is not feasible, transmural drainage of the PPF remains the preferred method. Endoscopic transmural drainage leads to closure of the fistula canal in patients with pancreatic fluid collection complicated by PPF.

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

Cited by 12 publications

References 34 publications

Endoscopic management of pancreatic walled-off necrosis

Endoscopic management of pancreatic walled-off necrosis

Endoscopic management of pancreatic fluid collections with disconnected pancreatic duct syndrome

Endoscopic treatment of pancreaticopleural fistulas

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