Disconnected Pancreatic Duct Syndrome: Pancreatitis of the Disconnected Pancreas and Its Role in the Development of Diabetes Mellitus

Thiruvengadam, Nikhil R.; Forde, Kimberly A.; Miranda, Janille; Kim, Christopher; Behr, Spencer C.; Masharani, Umesh; Arain, Mustafa A.

doi:10.14309/ctg.0000000000000457

Cited by 12 publications

(7 citation statements)

References 42 publications

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“…Several studies have found that DPD has a significant effect on the occurrence of NOD [49,50]. Despite the higher frequency of DPD in NOD patients compared to non-DM patients, we found that DPD was not related to the occurrence of DM in our study.…”

Section: Discussioncontrasting

confidence: 92%

New-onset Diabetes Mellitus after EUS-guided Drainage with LAMS: A Pilot Study

Man,

Spulber Sfara,

Neamti

et al. 2024

JGLD

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Background and Aims: Walled-off necrosis (WON) is a serious complication of severe pancreatitis, patients with necrotizing pancreatitis having an increased risk of developing diabetes mellitus (DM). The aim of this study was to assess the frequency of new-onset diabetes (NOD) in patients with symptomatic WON after endoscopic ultrasound (EUS)-guided drainage with lumen-apposing metal stents (LAMS). Methods: We retrospectively analyzed a prospectively collected database of patients with symptomatic WON treated by EUS-guided drainage with LAMS in a tertiary referral center. The patients were followed-up for at least 12 months after stent removal. These patients were compared with age- and sex-matched asymptomatic WON controls without interventional treatment and healthy controls to assess the one-year occurrence of DM. Diabetes was defined according to the American Diabetes Association criteria. Results: Of the 50 patients with symptomatic WON included in the study (male/female ratio, 33:17; median age, 60 years), 13 patients (26%) had pre-existing DM and were excluded. Ten of the remaining 37 patients (27%) without prior DM developed NOD within one year after stent removal, this frequency being higher than in asymptomatic WON controls (18.9%, p=0.581) and healthy controls (2%, p = 0.002). In the symptomatic WON group, NOD patients compared to non-DM patients were older (63.5 vs. 56 years old, p=0.042), had more frequent necrosis > 50% of the pancreatic parenchyma (p=0.002) and had a body-tail location of WON (p<0.001). On multivariate analysis, the number of direct endoscopic necrosectomy (DEN) sessions was the only significant factor for NOD occurrence (OR=7.05, p=0.010). NOD patients had poor glycemic control and required more DEN sessions to achieve WON resolution than patients with prior DM (p=0.017). Conclusions: In patients with symptomatic WON treated by EUS-guided drainage, DM occurred in 27% of previously non-diabetic patients within one year of follow-up. Patients with extensive pancreatic necrosis were more likely to develop NOD, a high number of DEN sessions being a significant risk factor for NOD occurrence.

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Section: Discussioncontrasting

confidence: 92%

New-onset Diabetes Mellitus after EUS-guided Drainage with LAMS: A Pilot Study

Man,

Spulber Sfara,

Neamti

et al. 2024

JGLD

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“…Among imaging characteristics, necrosis with diffuse involvement of pancreas (head, body, and tail) was an independent predictor, potentially reflecting the fact that extensive necrosis and/or necrosectomy could result in islet cell destruction leading to NOD. The presence of DPD/segment on imaging was a significant predictor for NOD only on univariable analysis, which is consistent with 2 recent observational studies 33,34 . It has been hypothesized that ductal hypertension in the disconnected segment of pancreatic duct could lead to persistent inflammation, fibrosis, and atrophy of the upstream pancreas over time, which could predispose to NOD 33 .…”

Section: Discussionsupporting

confidence: 85%

“…The presence of DPD/segment on imaging was a significant predictor for NOD only on univariable analysis, which is consistent with 2 recent observational studies. 33,34 It has been hypothesized that ductal hypertension in the disconnected segment of pancreatic duct could lead to persistent inflammation, fibrosis, and atrophy of the upstream pancreas over time, which could predispose to NOD. 33 It is important to emphasize that DPD is not necessarily obvious on initial imaging (as assessed in this study), and DPD syndrome manifests mainly as a late sequelae of NP.…”

Section: Discussionmentioning

confidence: 99%

Visceral Fat Predicts New-Onset Diabetes After Necrotizing Pancreatitis

Trikudanathan,

Abdallah,

Munigala

et al. 2024

Pancreas

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Objectives We aimed to estimate the incidence of new-onset diabetes (NOD) and identify risk factors for NOD in patients with necrotizing pancreatitis (NP). Methods Necrotizing pancreatitis patients were reviewed for NOD, diagnosed >90 days after acute pancreatitis. Baseline demographics, comorbidities, clinical outcomes, computed tomography (CT) characteristics of necrotic collections, and CT-derived abdominal fat measurements were analyzed to identify predictors for NOD. Results Among 390 eligible NP patients (66% men; median age, 51 years; interquartile range [IQR], 36–64) with a median follow-up of 400 days (IQR, 105–1074 days), NOD developed in 101 patients (26%) after a median of 216 days (IQR, 92–749 days) from NP. Of the NOD patients, 84% required insulin and 69% developed exocrine pancreatic insufficiency (EPI). Age (odds ratio [OR], 0.98), male sex (OR, 2.7), obesity (OR, 2.1), presence of EPI (OR, 2.7), and diffuse pancreatic necrosis (OR, 2.4) were independent predictors. In a separate multivariable model assessing abdominal fat on CT, visceral fat area (highest quartile) was an independent predictor for NOD (OR, 3.01). Conclusions New-onset diabetes was observed in 1 of 4 patients with NP, most within the first year and requiring insulin. Male sex, obesity, diffuse pancreatic necrosis, development of EPI, and high visceral adiposity identified those at highest risk.

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“…Thiruvengadam et al 18 performed a study in 2022 where 171 patients with necrotizing pancreatitis undergoing conservative and/or surgical management ( Table 2 ) were identified and followed up. Forty-eight patients (28.1%) developed DPDS and the rate of DPDS incidence was 40% (42 patients) in 104 patients who had at least 36 months of the radiographic follow-up ( Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

DPDS Demystified: Imaging Insights and Minimally Invasive Management

Rathi,

Koteshwar

2024

Journal of Gastrointestinal and Abdominal Radiology

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Aim This article retrospectively evaluates the radiological imaging features in establishing the diagnosis of pancreatic duct disconnection along with outlining the effective management protocols. Materials and Methods Sixty-three patients with radiological or clinical suspicion of pancreatic duct disconnection were identified. Their computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) images, clinical data, and laboratory parameters from medical records were retrieved and analyzed. Endoscopic retrograde cholangiopancreatography (ERCP) findings or raised amylase values in the necrotic collection higher than three times the reference range were considered as proven cases of disconnected pancreatic duct syndrome (DPDS) for the study. Multiple parameters were assessed on imaging to establish the diagnosis of DPDS. SPSS software was used for statistical analysis and radiological imaging features of pancreatic duct disconnection were evaluated. Laboratory parameters of serum amylase/lipase and amylase/lipase values from the collection were also studied along with the mode of clinical management and outcome on follow-up. Results The radiological imaging features of pancreatic duct disconnection were assessed in 63 patients in which it was seen that magnetic resonance imaging had a significantly higher accuracy rate in diagnosing DPDS as opposed to CT. Minimally invasive procedures such as endoscopic cystogastrostomy was the preferred management in most cases with ERCP stenting being the next favored management of choice. Resolution or reduction of symptoms was mostly seen on follow-up with 12.69% of patients developing complications. Conclusion This study highlighted the imaging features of DPDS apart from ascertaining the parameters that could be assessed to aid in early diagnosis of DPDS. MRCP has a higher accuracy rate compared with CT in diagnosing DPDS. A combination of two or more parameters on MRCP was more accurate in the identification of DPDS rather than a single parameter. Minimally invasive treatment options such as endoscopic transluminal drainage with or without stenting are currently preferred in the treatment of DPDS over surgical management. Early diagnosis and prompt management of DPDS is essential to reduce the onset of serious complications apart from improving the quality of life of these patients posttreatment.

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Disconnected Pancreatic Duct Syndrome: Pancreatitis of the Disconnected Pancreas and Its Role in the Development of Diabetes Mellitus

Cited by 12 publications

References 42 publications

New-onset Diabetes Mellitus after EUS-guided Drainage with LAMS: A Pilot Study

New-onset Diabetes Mellitus after EUS-guided Drainage with LAMS: A Pilot Study

Visceral Fat Predicts New-Onset Diabetes After Necrotizing Pancreatitis

DPDS Demystified: Imaging Insights and Minimally Invasive Management

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