Transpapillary Stenting Improves Treatment Outcomes in Patients Undergoing Endoscopic Transmural Drainage of Ductal Disruption-Associated Pancreatic Fluid Collections : Official journal of the American College of Gastroenterology | ACG

Secondary Logo

Journal Logo

Advanced Search
ARTICLE: ENDOSCOPY

Transpapillary Stenting Improves Treatment Outcomes in Patients Undergoing Endoscopic Transmural Drainage of Ductal Disruption-Associated Pancreatic Fluid Collections

Ni, Jianbo MD1,2,*; Peng, Kui MD1,*; Yu, Lanting PhD1,2,*; Xie, Haoran MS1,2; Luo, Shengzheng MD1; Xu, Kai MS1; Xia, Youchen MD1; Xie, Ni MS1,2; Lu, Jiawei MS1,2; Lu, Lungen MD1; Hu, Duanmin MD3; Wan, Xinjian MD4; Li, Baiwen MD1,2

Author Information

1Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;

2Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;

3Department of Gastroenterology, The Second Hospital of Soochow University, Soochow, Jiangsu, China;

4Department of Gastroenterology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Correspondence: Baiwen Li, MD. E-mail: [email protected]. Xinjian Wan, MD. E-mail: [email protected].

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/C774

*Jianbo Ni, Kui Peng, and Lanting Yu are co-first authors.

The American Journal of Gastroenterology 118(6):p 972-982, June 2023. | DOI: 10.14309/ajg.0000000000002083
  • Buy
  • SDC
  • Infographic

Abstract

INTRODUCTION: 

Endoscopic transmural drainage (TMD) has been accepted as the preferred therapy for symptomatic pancreatic fluid collections (PFCs). Recurrence of PFCs presents a unique challenge in patients with disrupted pancreatic duct (PD). We aimed to evaluate whether transpapillary drainage (TPD) provides additional benefits to TMD in patients with PD disruption.

METHODS: 

This was a multicenter retrospective study. Consecutive patients who underwent TMD, TPD, or combined drainage (CD) of PFCs were included. The primary outcome was to compare PFC recurrence among different groups. The secondary outcomes were the technical success rate, length of hospital stay, and procedure-related complications.

RESULTS: 

A total of 153 patients, which consists of 57 patients with pancreatic pseudocysts and 96 patients with walled-off necrosis, were included. PFC recurrence was more common in patients with PD disruption than those with an intact main duct (19% vs 1.4%, P < 0.001). PD disruption was identified as a major risk factor of PFC recurrence by univariable and multivariable analyses. The recurrence rate of CD was significantly lower than TMD only or TPD only (6.5% vs 15.4% vs 22.7%, P < 0.01). The length of hospital stay of CD was significantly shorter than TMD only or TPD only (5 [3.0–9.0] vs 7.0 [5.0–12.0] vs 9 [7.0–16.0], P < 0.001). Dual-modality drainage did not increase procedure-related complications compared with TMD only (13.0% vs 12.8%, P > 0.05). Partial PD disruption was bridged in 87.3% cases while complete PD disruption was reconnected in 55.2% cases. Although statistically not significant, the clinical success rate in walled-off necrosis cases with actively bridged ducts was much higher than those with passively bridged ducts (76.9% vs 40%).

DISCUSSION: 

Transpapillary pancreatic duct stenting seems to improve the efficacy of endoscopic TMD of pancreatic duct disruption-associated PFCs by reducing the recurrence rate and shortening the length of hospital stay.

Abstract
Export

© 2023 by The American College of Gastroenterology

Full Text Access for Subscribers:

Log In Here
ACG Member Access
Log In Here

Not a Subscriber?

Buy
Request Permissions

You can read the full text of this article if you:

Access through Ovid