Eric Chong1, Chathura Bathiya Ratnayake1, Samantha Saikia2, Manu Nayar3, Kofi Oppong3, Jeremy J French4, John A Windsor1, Sanjay Pandanaboyana5,6. 1. Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 2. Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK. 3. Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK. 4. HPB and Transplant Unit, Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. 5. HPB and Transplant Unit, Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. sanjay.pandanaboyana@gmail.com. 6. Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK. sanjay.pandanaboyana@gmail.com.
Abstract
BACKGROUND: Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. METHODS: The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites. RESULTS: Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P = 0.389). CONCLUSIONS: Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.
BACKGROUND: Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. METHODS: The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites. RESULTS: Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P = 0.389). CONCLUSIONS: Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.
Authors: Shyam Varadarajulu; Tara C Noone; Radu Tutuian; Robert H Hawes; Peter B Cotton Journal: Gastrointest Endosc Date: 2005-04 Impact factor: 9.427
Authors: Sven M van Dijk; Hester C Timmerhuis; Robert C Verdonk; Evelien Reijnders; Marco J Bruno; Paul Fockens; Rogier P Voermans; Marc G Besselink; Hjalmar C van Santvoort Journal: Pancreatology Date: 2019-08-14 Impact factor: 3.996
Authors: Michael Gluck; Andrew Ross; Shayan Irani; Otto Lin; S Ian Gan; Mehran Fotoohi; Ellen Hauptmann; Robert Crane; Justin Siegal; David H Robinson; L W Traverso; Richard A Kozarek Journal: J Gastrointest Surg Date: 2011-11-29 Impact factor: 3.452
Authors: Shayan Irani; Michael Gluck; Andrew Ross; S Ian Gan; Robert Crane; John J Brandabur; Ellen Hauptmann; Mehran Fotoohi; Richard A Kozarek Journal: Gastrointest Endosc Date: 2012-09 Impact factor: 9.427
Authors: Ji Young Bang; C Mel Wilcox; Jessica Trevino; Jayapal Ramesh; Shajan Peter; Muhammad Hasan; Robert H Hawes; Shyam Varadarajulu Journal: J Gastroenterol Hepatol Date: 2013-11 Impact factor: 4.029
Authors: Mark Tann; Dean Maglinte; Thomas J Howard; Stuart Sherman; Evan Fogel; James A Madura; Glen A Lehman Journal: J Comput Assist Tomogr Date: 2003 Jul-Aug Impact factor: 1.826