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A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption

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Abstract

Background and Aims

Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach.

Methods

This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative (n = 26) or traumatic (n = 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and N-butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption.

Results

PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients.

Conclusions

Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities.

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Authors and Affiliations

  1. Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, 06800, Çankaya, Ankara, Turkey

    Bülent Ödemiş, Muhammed Bahaddin Durak, Ali Atay, Batuhan Başpınar & Çağdaş Erdoğan

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  1. Bülent Ödemiş
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  2. Muhammed Bahaddin Durak
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  3. Ali Atay
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  4. Batuhan Başpınar
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  5. Çağdaş Erdoğan
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Contributions

All authors above contributed the following aspects of the manuscript: conception and design, analysis and interpretation of the data, drafting of the article, critical revision of the article for important entellectual content, final approval of the article.

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Correspondence to Bülent Ödemiş.

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Conflict of interest

Dr. Bülent Ödemiş, Dr. Muhammed Bahaddin Durak, Dr. Ali Atay, Dr. Batuhan Başpınar and Dr. Çağdaş Erdoğan have no conflicts of interests to disclose, and there was no financial support associated with this study to declare.

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Ödemiş, B., Durak, M.B., Atay, A. et al. A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption. Dig Dis Sci 68, 3745–3755 (2023). https://doi.org/10.1007/s10620-023-07996-0

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  • DOI: https://doi.org/10.1007/s10620-023-07996-0

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