When Draining Walled-Off Pancreatic Necrosis, Attention to Disconnected Pancreatic Duct Syndrome Guides Terminal Steps in Therap
Von /

When Draining Walled-Off Pancreatic Necrosis, Attention to Disconnected Pancreatic Duct Syndrome Guides Terminal Steps in Therap

Bret T. Petersen, MD, MASGE, reviewing Bang JY, et al. Clin Gastroenterol Hepatol 2020 Jul 16.

Internal drainage using large-caliber lumen-apposing metal stents (LAMS) is now a dominant therapy for acute fluid collections and walled-off pancreatic necrosis associated with acute pancreatitis. Disconnected pancreatic duct syndrome (DPDS) is common among these patients. In this prospective observational study of endoscopic drainage for pancreatic fluid collections, LAMS were placed in 188 such patients, 94 of whom had DPDS confirmed by either MRCP or ERCP. In patients with DPDS, the LAMS was replaced approximately 1 month after the index procedure with two 7 Fr x 4 cm double-pigtail plastic stents to maintain persistent pancreatico-gastric or duodenal fistulae. This was successfully performed in 70 (74.5%) of the 94 patients with DPDS. During a median of 6 months follow-up, recurrent collections developed in 7 patients with DPDS, including 1 (1.4%) of the 70 patients with long-term plastic stent drainage, versus 6 (25%) of the 24 patients with unsuccessful plastic stent placement (P=.001).

Bret T. Petersen, MD, FASGE

COMMENT

This study quantifies the recurrence of fluid collections in patients with disconnected pancreatic duct syndrome following completion of internal drainage for fluid collections related to acute pancreatitis. Without a persistent stent to maintain an internal fistula to the GI tract, one-quarter of fluid collections recurred. The long-term outcome of such stenting remains unknown. Intuitively, those with large disconnected segments, significant comorbidities, and advanced age appear to warrant stenting indefinitely. The long-term risk versus benefit for young patients or those with small disconnected sectors remains uncertain. Should recurrence occur, development of a local collection is usually easily managed with EUS-guided cyst-gastrostomy at that point in time.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Bang JY, Wilcox CM, Arnoletti JP, Varadarajulu S. Importance of disconnected pancreatic duct syndrome in recurrence of pancreatic fluid collections initially drained using lumen-apposing metal stents. Clin Gastroenterol Hepatol 2020 Jul 16. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.07.022)

Ähnliche Beiträge

VOR
Nach oben scrollen