Disconnected pancreatic duct syndrome in severe acute pancreatitis

clinical and imaging characteristics and outcomes in a cohort of 31 cases

Mario Pelaez-Luna, Santhi Swaroop Vege, Bret Thomas Petersen, Suresh T Chari, Jonathan E. Clain, Michael J. Levy, Randal K. Pearson, Mark Topazian, Michael B. Farnell, Michael L. Kendrick, Todd H. Baron

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)91-97
Number of pages7
JournalGastrointestinal Endoscopy
Volume68
Issue number1
DOIs
StatePublished - Jul 2008

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Pancreatic Ducts
Pancreatitis
Chronic Pancreatitis
Diabetes Mellitus
Demography
Mortality
Endoscopic Retrograde Cholangiopancreatography
Lost to Follow-Up
Therapeutics
Natural History
Tertiary Care Centers
Endoscopy
Atrophy
Drainage
Pancreas
Neck
Databases

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Disconnected pancreatic duct syndrome in severe acute pancreatitis : clinical and imaging characteristics and outcomes in a cohort of 31 cases. / Pelaez-Luna, Mario; Vege, Santhi Swaroop; Petersen, Bret Thomas; Chari, Suresh T; Clain, Jonathan E.; Levy, Michael J.; Pearson, Randal K.; Topazian, Mark; Farnell, Michael B.; Kendrick, Michael L.; Baron, Todd H.

In: Gastrointestinal Endoscopy, Vol. 68, No. 1, 07.2008, p. 91-97.

Research output: Contribution to journalArticle

Pelaez-Luna, Mario ; Vege, Santhi Swaroop ; Petersen, Bret Thomas ; Chari, Suresh T ; Clain, Jonathan E. ; Levy, Michael J. ; Pearson, Randal K. ; Topazian, Mark ; Farnell, Michael B. ; Kendrick, Michael L. ; Baron, Todd H. / Disconnected pancreatic duct syndrome in severe acute pancreatitis : clinical and imaging characteristics and outcomes in a cohort of 31 cases. In: Gastrointestinal Endoscopy. 2008 ; Vol. 68, No. 1. pp. 91-97.
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abstract = "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.",
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AU - Chari, Suresh T

AU - Clain, Jonathan E.

AU - Levy, Michael J.

AU - Pearson, Randal K.

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