Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Am J Gastroenterol. 2023 Jun 1;118(6):972-982. doi: 10.14309/ajg.0000000000002083. Epub 2022 Dec 20.
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.
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.
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%).
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.
内镜经黏膜下隧道引流（TMD）已被接受为治疗有症状胰腺液体积聚（PFC）的首选疗法。在胰腺导管（PD）破裂的患者中，PFC 的复发是一个独特的挑战。我们旨在评估 PD 破裂患者的经乳头引流（TPD）是否为 TMD 提供了额外的益处。
这是一项多中心回顾性研究。纳入接受 TMD、TPD 或联合引流（CD）治疗 PFC 的连续患者。主要结局是比较不同组之间 PFC 的复发情况。次要结局是技术成功率、住院时间和与操作相关的并发症。
共纳入 153 例患者，其中胰腺假性囊肿 57 例，胰腺包裹性坏死 96 例。PD 破裂患者的 PFC 复发率高于主胰管完整患者（19%比 1.4%，P<0.001）。单变量和多变量分析均表明 PD 破裂是 PFC 复发的主要危险因素。CD 的复发率明显低于 TMD 或 TPD （6.5%比 15.4%比 22.7%，P<0.01）。CD 的住院时间明显短于 TMD 或 TPD （5[3.0-9.0]比 7.0[5.0-12.0]比 9[7.0-16.0]，P<0.001）。与 TMD 相比，双模式引流并未增加与操作相关的并发症（13.0%比 12.8%，P>0.05）。87.3%的病例中部分 PD 破裂得以桥接，55.2%的病例中完全 PD 破裂得以再连接。虽然统计学上无显著意义，但主动桥接导管的胰腺包裹性坏死病例的临床成功率明显高于被动桥接导管（76.9%比 40%）。
经乳头胰管支架似乎通过降低复发率和缩短住院时间来提高内镜 TMD 治疗 PD 破裂相关 PFC 的疗效。
