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

Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study

“…Second, although the decision to proceed with TP was per the endoscopist's discretion and in some cases performed routinely in the management of pseudocysts; other potential reasons were not captured in this study. Furthermore, in aggregate, the rates of symptom and radiologic resolution (60.3%-72.4%) of pseudocysts after endoscopic drainage in this study appear to be lower than those reported in the literature, which range from 75% to 100% [18][19][20][21][22][23][24][25][26].…”

“…In 2 separate studies, successful placement of a bridging PD stent across a disruption/leak was reported in the range of 40.2% for pseudocysts to as low as 17.5% for WON [11,16]. Cited reasons for failure include complete ductal disruption, inability to complete the ERP due to luminal obstruction, surgically altered anatomy, and/or failed PD cannulation [10,11,26]. Furthermore, as shown in a subgroup analysis in this study, even when a PD stent is successfully placed across the leak/disruption in patients who undergo CD, there was no difference in treatment outcomes when compared with patients who underwent TM alone.…”

EUS-guided pseudocyst drainage: prospective evaluation of early removal of fully covered self-expandable metal stents with pancreatic ductal stenting in selected patients

“…[8][9][10] Several studies have shown that pancreatic ductal stenting in patients with ductal leak improves the outcome in patients with pseudocysts. 11,12 However, all of these studies used plastic stents for cystoenterostomy. In a retrospective study involving 110 patients, those who underwent additional ductal stenting had a significantly higher chance of treatment success than those who underwent cystoenterostomy alone (97.5% vs 80%, P Z .01).…”

Indications for ERCP

“…A study investigating the role of PD stenting in ductal disruption demonstrated that in 21 out of 28 patients with partial PD disruption who were treated with PD stent alone, the disruption resolved. In six out of eight patients with complete PD disruption, the disruption resolved with PD stenting alone as well [19].…”