Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases

• Published in: Gastrointestinal endoscopy Vol. 68; no. 1; pp. 91 - 97
• Main Authors: Pelaez-Luna, Mario, MD, Vege, Santhi Swaroop, MD, Petersen, Bret T., MD, Chari, Suresh T., MD, Clain, Jonathan E., MD, Levy, Michael J., MD, Pearson, Randal K., MD, Topazian, Mark D., MD, Farnell, Michael B., MD, Kendrick, Michael L., MD, Baron, Todd H., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2008; Elsevier
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde - methods; Cohort Studies; Diagnostic Imaging - methods; Digestive system. Abdomen; Drainage - methods; Endoscopy; Endoscopy - methods; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparotomy - methods; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pancreatic Ducts - abnormalities; Pancreatic Ducts - surgery; Pancreatic Fistula - etiology; Pancreatic Fistula - surgery; Pancreatic Pseudocyst - etiology; Pancreatic Pseudocyst - pathology; Pancreatic Pseudocyst - surgery; Pancreatitis - complications; Pancreatitis - diagnosis; Pancreatitis - mortality; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate; Syndrome; Tomography, X-Ray Computed; Treatment Outcome; MPD; chronic pancreatitis; SAP; DM; diabetes mellitus; CP; AP; main pancreatic duct; analysis of variance; ANOVA; severe acute pancreatitis; acute pancreatitis; DPDS; disconnected pancreatic duct syndrome; Symptomatology; Prognosis; Acute; Pancreatitis; Digestive diseases; Pancreatic duct; Pancreatic disease
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.11.041

Background Information regarding the natural history, clinical characteristics, and outcomes of disconnected pancreatic duct syndrome (DPDS) is limited. Objective To describe clinical characteristics and outcomes of DPDS. Design A retrospective review of the Mayo Clinic endoscopy and hospital service database. Setting Tertiary-referral center. Patients We identified 31 DPDS cases from 1999 to 2006. Interventions Endoscopic drainage of pancreatic-fluid collections. Main Outcome Measurements The relationship between demographic and clinical data with endoscopic treatment and clinical outcomes in DPDS cases. Results The median patient age was 53 years (range 20-83 years); 48% were men. The most common etiology of acute pancreatitis (AP) was biliary (55%) followed by idiopathic (27%). The median interval between the diagnoses of AP and DPDS was 56 days (range 3-251 days); the median follow-up after the last ERCP or surgical procedure was 7 months (range 0-90 months). The DPDS location included the following: pancreas head 6%, neck 58%, body 26%, and tail 10%. Twenty-six patients had initial endoscopic treatment (19 had long-term improvement; 7 failed treatment and required surgery) and 5 underwent immediate surgery. Mortality was 0%; 26% developed chronic pancreatitis (CP) and 16% diabetes mellitus (DM); 10% resolved completely, 45% had smaller fluid collections, and 26% patients were lost to follow-up. No relationship between demographic and clinical data with endoscopic and clinical outcomes was found. Conclusions Endoscopic treatment temporarily improved DPDS, with a failure rate of 23%. Immediate surgery was not required in all cases. CP and/or pancreatic atrophy occurred relatively shortly after the DPDS diagnosis in 26% and DM in 16% of cases. DPDS did not lead to mortality. Early surgery may be considered after initially stabilizing the fluid collection with endoscopic therapy.