Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK.
BMC Gastroenterol. 2021 Feb 25;21(1):87. doi: 10.1186/s12876-021-01663-2.
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.
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.
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).
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.
胰腺导管分离综合征（DPDS）是胰腺颈部和体部急性坏死性胰腺炎的并发症，常表现为持续性胰液积聚（PFC）或外胰腺瘘（EPF）。本系统评价和成对荟萃分析旨在回顾 DPDS 的定义、临床表现、干预和结局。
采用 PRISMA 框架系统检索 PubMed、EMBASE、MEDLINE 和 SCOPUS 数据库，检索时间截至 2020 年 2 月。采用荟萃分析评估内镜和手术干预治疗 DPDS 的成功率。DPDS 治疗成功定义为 PFC、EPF 或胰腺腹水无复发的长期症状缓解。
纳入的 30 项研究共包含 1355 例患者，定量分析结果显示，最常见的病因是急性胰腺炎（95.3%，936/982），其次是慢性胰腺炎（3.1%，30/982）。DPDS 常表现为 PFC（83.2%，948/1140）和 EPF（13.4%，153/1140）。文献中 DPDS 的定义存在显著异质性。内镜经壁引流的加权成功率（90.6%，95%-CI 81.0-95.6%）显著高于经乳头引流（58.5%，95%-CI 36.7-77.4%）。成对荟萃分析显示，内镜和手术干预的成功率相当，分别为 82%（加权 95%-CI 68.6-90.5%）和 87.4%（95%-CI 81.2-91.8%）（P=0.389）。
内镜经壁引流在 DPDS 治疗中优于经乳头引流。内镜和手术干预的成功率相当。DPDS 的定义和治疗策略存在显著差异，需要进一步研究标准化。
