Skip to main content
SpringerLink
Log in

The role of endoscopic treatment of pancreatic duct disruption in patients with walled-off pancreatic necrosis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The place of endoscopic techniques in the treatment of main pancreatic duct (MPD) disruption arising in the course of acute necrotizing pancreatitis (ANP) remains unclear. The aim of this study was to describe the findings of endoscopic retrograde pancreatography (ERP) in patients with walled-off necrosis (WON). It was attempted to evaluate the role of endoscopic treatment of pancreatic duct disruption in patients with WON.

Methods

The retrospective analysis of results and complications with particular emphasis to all ERP procedures in the group of 226 patients was conducted, which underwent endoscopic treatment of symptomatic WON between years 2001 and 2016 in the Department of Gastroenterology and Hepatology of Medical University of Gdańsk.

Results

ERP was performed in 204/226 (90.27%) patients. Partial and complete disruption of the MPD were identified in 103 (50.49%) and 63 (30.89%) out of 204 patients, respectively. Endoscopic treatment was used in all 166 patients with MPD disruption. The success of endoscopic treatment of MPD disruption was achieved in 138/161 (85.71%) patients with WON. The therapeutic success of WON endotherapy was achieved in 214/226 (94.69%) patients. The mean follow-up duration was 56 (SD = 37.06) [range 14–158] months. Long-term success of treatment of WON was achieved in 182/226 (80.53%) patients.

Conclusions

MPD disruption occurs in the majority of patients with WON. Partial disruption of the MPD is more frequent than complete disruption of the duct. This study conducted on a large group of patients demonstrated that prosthesis insertion into the MPD in patients with disruption of the MPD in the course of ANP is one of the key elements in endoscopic treatment of WON. Passive transpapillary drainage is an effective method of treating MPD disruptions, which improves long-term outcomes of endoscopic treatment in patients with WON.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Diagram 1
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Diagram 2

Similar content being viewed by others

References

  1. Jang JW, Kim MH, Oh D, Cho DH, Song TJ, Park DH, Lee SS, Seo DW, Lee SK, Moon SH (2016) Factors and outcomes associated with pancreatic duct disruption in patients with acute necrotizing pancreatitis. Pancreatology 16:958–965

    Article  Google Scholar 

  2. Deviere J, Bueso C, Baize M, Azar C, Love J, Moreno E, Cremer M (1995) Complete disruption of the pancreatic duct: endoscopic management. Gastrointest Endosc 42:445–451

    Article  CAS  Google Scholar 

  3. Devière J, Antaki F (2008) Disconnected pancreatic tail syndrome: a plea for multidisciplinarity. Gastrointest Endosc 67:680–682

    Article  Google Scholar 

  4. Varadarajulu S, Noone TC, Tutuian R, Hawes RH, Cotton PB (2005) Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc 61:568–575

    Article  Google Scholar 

  5. Smoczyński M, Marek I, Dubowik M, Rompa G, Kobiela J, Studniarek M, Pieńkowska J, Adrych K (2014) Endoscopic drainage/debridement of walled-off pancreatic necrosis—single center experience of 112 cases. Pancreatology 14:137–142

    Article  Google Scholar 

  6. Jagielski M, Smoczyński M, Jabłońska A, Marek I, Dubowik M, Adrych K (2015) The role of endoscopic ultrasonography in endoscopic debridement of walled-off pancreatic necrosis-a single center experience. Pancreatology 15:503–507

    Article  Google Scholar 

  7. da Costa DW, Boerma D, van Santvoort HC, Horvath KD, Werner J, Carter CR, Bollen TL, Gooszen HG, Besselink MG, Bakker OJ (2014) Staged multidisciplinary step-up management for necrotizing pancreatitis. Br J Surg 101:e65–e79

    Article  Google Scholar 

  8. Jagielski M, Smoczyński M, Adrych K (2018) Endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticocolonic fistula. Surg Endosc 32:1572–1580

    Article  Google Scholar 

  9. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111

    Article  Google Scholar 

  10. Thoeni RF (2012) The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 262:751–764

    Article  Google Scholar 

  11. Baron TH, Thaggard WG, Morgan DE, Stanley RJ (1996) Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 111:755–764

    Article  CAS  Google Scholar 

  12. Varadarajulu S, Phadnis MA, Christein JD, Wilcox CM (2011) Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis. Gastrointest Endosc 74:74–80

    Article  Google Scholar 

  13. Jagielski M, Smoczyński M, Adrych K (2017) Endoscopic treatment of multilocular walled-off pancreatic necrosis with the multiple transluminal gateway techniques. Videosurg Miniinv Tech 12:199–205

    Article  Google Scholar 

  14. Jagielski M, Smoczyński M, Jabłońska A, Adrych K (2018) The development of endoscopic techniques for treatment of walled-off pancreatic necrosis (WOPN)—a single center experience. Gastroenterol Res Pract 2018:1–9

    Article  Google Scholar 

  15. Mukai S, Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N, Tanaka R, Umeda J, Tonozuka R, Honjo M, Moriyasu F (2014) Novel single transluminal gateway transcystic multiple drainages after EUS-guided drainage for complicated multilocular walled-off necrosis (with videos). Gastrointest Endosc 79:531–535

    Article  Google Scholar 

  16. Smoczyński M, Jagielski M, Jabłońska A, Adrych K (2015) Transpapillary drainage of walled-off pancreatic necrosis- a single center experience. Wideochir Inne Tech Maloinwazyjne 10:527–533

    PubMed  PubMed Central  Google Scholar 

  17. Trevino JM, Tamhane A, Varadarajulu S (2010) Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections. J Gastroenterol Hepatol 25:526–531

    Article  Google Scholar 

  18. Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J (2006) Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc 63:635–643

    Article  Google Scholar 

  19. Yang D, Amin S, Gonzalez S, Mullady D, Hasak S, Gaddam S, Edmundowicz SA, Gromski MA, DeWitt JM, El Zein M, Khashab MA, Wang AY, Gaspar JP, Uppal DS, Nagula S, Kapadia S, Buscaglia JM, Bucobo JC, Schlachterman A, Wagh MS, Draganov PV, Jung MK, Stevens T, Vargo JJ, Khara HS, Huseini M, Diehl DL, Keswani RN, Law R, Komanduri S, Yachimski PS, DaVee T, Prabhu A, Lapp RT, Kwon RS, Watson RR, Goodman AJ, Chhabra N, Wang WJ, Benias P, Carr-Locke DL, DiMaio CJ (2016) Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study. Gastrointest Endosc 86:720–729

    Article  Google Scholar 

  20. Shrode CW, Macdonough P, Gaidhane M, Northup PG, Sauer B, Ku J, Ellen K, Shami VM, Kahaleh M (2013) Multimodality endoscopic treatment of pancreatic duct disruption with stenting and pseudocyst drainage: how efficacious is it? Dig Liver Dis 45:129–133

    Article  Google Scholar 

  21. Lawrence C, Howell DA, Stefan AM, Conklin DE, Lukens FJ, Martin RF, Landes A, Benz B (2008) Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of long-term follow-up. Gastrointest Endosc 67:673–679

    Article  Google Scholar 

  22. Shyu JY, Sainani NI, Sahni VA, Chick JF, Chauhan NR, Conwell DL, Clancy TE, Banks PA, Silverman SG (2014) Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics 34:1218e39

    Article  Google Scholar 

  23. Yokoi Y, Kikuyama M, Kurokami T, Sato T (2016) Early dual drainage combining transpapillary endotherapy and percutaneous catheter drainage in patients with pancreatic fistula associated with severe acute pancreatitis. Pancreatology 16:497–507

    Article  Google Scholar 

  24. Bazerbachi F, Swas T, Vargas EJ, Prokop LJ, Chari ST, Gleeson FC, Levy MJ, Martin J, Petersen BT, Pearson RK, Topazian MD, Vege SS, Abu Dayyeh BK (2018) Metal Stents versus plastic stents for the management of pancreatic walled-off necrosis: a systematic review and meta-analysis. Gastrointest Endosc 87:30–42

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Medical University of Gdansk, Smoluchowskiego 17, 80-214, Gdansk, Poland

    Mateusz Jagielski, Marian Smoczyński & Krystian Adrych

Authors
  1. Mateusz Jagielski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marian Smoczyński
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krystian Adrych
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mateusz Jagielski.

Ethics declarations

Disclosures

Mateusz Jagielski, Marian Smoczyński, Krystian Adrych have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jagielski, M., Smoczyński, M. & Adrych, K. The role of endoscopic treatment of pancreatic duct disruption in patients with walled-off pancreatic necrosis. Surg Endosc 32, 4939–4952 (2018). https://doi.org/10.1007/s00464-018-6255-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6255-4

Keywords

Search

Navigation