Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis

Abstract

Background Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites. Results Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0–95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7–77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6–90.5) and 87.4% (95%-CI 81.2–91.8), respectively (P = 0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

Disconnected pancreatic duct syndrome and outcomes of endoscopic ultrasound‐guided treatment of pancreatic fluid collections: Systematic review and meta‐analysis

“…Plastic stent placement via endoscopic transpapillary approach has been utilized to reconnect proximal and distal pancreatic ducts, and thereby facilitate physiological outflow of the pancreatic juice into the duodenum 4,5 . More recently, endoscopic ultrasound (EUS)‐guided approach to pancreatic fluid collections (PFCs) has become a major treatment option with high technical feasibility 4–6 …”

“…4,5 More recently, endoscopic ultrasound (EUS)-guided approach to pancreatic fluid collections (PFCs) has become a major treatment option with high technical feasibility. [4][5][6] Pancreatic fluid collections including walled-off necrosis (WON) and pseudocyst are local complications associated with acute pancreatitis. 7,8 With increasing popularity of EUS-guided transmural interventions, patients with symptomatic PFC are commonly managed via non-surgical procedures.…”

EUS-Guided Rendezvous and Tractogastrostomy: A Novel Technique for Disconnected Pancreatic Duct Syndrome with External Pancreatic Fistula

“…A recent metanalysis has shown superiority of transmural drainage over the transpapillary drainage in the management of DPDS. 16 Studies with pancreatic fluid collections and the EPF were included in the analysis. In our study, all the patients had failure of conventional ERCP and were successfully managed with transmural technique.…”

Síndrome de desconexión del conducto pancreático

“…Es de especial interés, al observar el éxito de las distintas técnicas endoscópicas, la revisión que realiza Chong el año 2021, donde se compararon 30 estudios conglomerando un n de 1,355 pacientes con síndrome de desconexión pancreática, principalmente, secundario a pancreatitis aguda (95,3%) y presentándose como colección pancreática (83,2%). En esta revisión se observó que el éxito del drenaje transmural alcanzó una tasa de éxito del 90,6% (95% CI 81,0-95,6%) en comparación con el drenaje transpapilar que presentó una tasa de solo un 58,5% (95% CI 36,7-77,4%) 21 .…”

“…La tasa de éxito demostrada por los procedimientos endoscópicos en comparación con la cirugía también ha sido estudiada en la revisión de Chong 21 . No se observaron diferencias estadísticamente significativas al comparar la terapia endoscópica en general con la cirugía, mostrando una tasa de éxito de un 82% (95% CI 68,6-90,5%) vs. 87,4% (95% CI 81,2-91,8%) respectivamente (p = 0,389).…”