Koutlas Nicholas, Bentley Blake, Dorrell Robert, Ferris Taylor, Pawa Rishi
Department of Medicine, Section on Gastroenterology, Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC, USA.
Department of Medicine, Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC, USA.
Transl Gastroenterol Hepatol. 2024 Jan 25;9:4. doi: 10.21037/tgh-23-94. eCollection 2024.
Disconnected pancreatic duct syndrome (DPDS) is a common cause of recurrent pancreatic fluid collections (PFCs), often requiring repeat drainage. Following initial drainage with lumen apposing metal stents (LAMS), replacement with transmural double pigtail stents (DPS) has been shown to be a viable drainage modality mitigating the risk of recurrence. The sparsity of literature on the consequences of this strategy requires further investigation. We analyze our outcomes of long-term transmural drainage with DPS in patients with DPDS and assess the safety and efficacy of this technique.
This retrospective review of a prospectively maintained database from November 2015-May 2022 included all patients with DPDS who underwent removal of LAMS and replacement with long-term transmural DPS. Patient demographics, collection characteristics, drainage technique and outcomes, as well as follow-up data was collected and analyzed using descriptive statistics.
There were 139 patients who underwent endoscopic drainage of PFCs with LAMS during the study period. Seventy-eight patients [walled-off necrosis (n=65) and pseudocysts (n=13)] were found to have DPDS. Of these, 44 patients underwent successful LAMS removal followed by replacement with DPS and were included in the analysis. The median age was 57 years and 14 (32%) were female. The median stent dwell time was 394 days [interquartile range (IQR) 245, 853 days]. Spontaneous stent migration was seen in seven patients (16%), one of whom developed a PFC recurrence which was managed conservatively. The second recurrence was seen in a patient with indwelling DPS which did not require further intervention. There were no locoregional adverse events secondary to long-term indwelling DPS. Among the 28 patients who were followed for a year, three patients developed new-onset diabetes, and chronic pancreatitis (CP) changes in the disconnected segment were seen in eight patients, five of whom required pancreatic enzyme supplementation.
Placement of long-term transmural DPS is an effective modality for preventing collection re-accumulation with a favorable safety profile. Randomized prospective studies are essential to investigate the optimal removal timing of indwelling stents to prevent loco-regional complications. Given the realized risk of CP in the disconnected pancreas, follow-up cross sectional imaging may help guide further therapy.
胰腺导管离断综合征（DPDS）是复发性胰液积聚（PFCs）的常见原因，常需反复引流。在最初使用管腔对合金属支架（LAMS）引流后，用经壁双猪尾支架（DPS）替代已被证明是一种可行的引流方式，可降低复发风险。关于该策略后果的文献稀少，需要进一步研究。我们分析了DPDS患者长期经壁DPS引流的结果，并评估了该技术的安全性和有效性。
对2015年11月至2022年5月前瞻性维护的数据库进行回顾性分析，纳入所有接受LAMS取出并替换为长期经壁DPS的DPDS患者。收集患者人口统计学资料、积液特征、引流技术及结果以及随访数据，并使用描述性统计进行分析。
研究期间有139例患者接受了LAMS内镜下引流PFCs。78例患者[包裹性坏死（n = 65）和假性囊肿（n = 13）]被发现患有DPDS。其中，44例患者成功取出LAMS后替换为DPS并纳入分析。中位年龄为57岁，14例（32%）为女性。支架中位留置时间为394天[四分位间距（IQR）245，853天]。7例患者（16%）出现支架自发移位，其中1例发生PFC复发，经保守治疗。第2例复发见于1例留置DPS的患者，无需进一步干预。长期留置DPS未引起局部不良事件。在随访1年的28例患者中，3例患者出现新发糖尿病，8例患者在离断段出现慢性胰腺炎（CP）改变，其中5例需要补充胰酶。
长期放置经壁DPS是预防积液再次积聚的有效方式，安全性良好。随机前瞻性研究对于调查留置支架的最佳取出时机以预防局部并发症至关重要。鉴于离断胰腺中已认识到的CP风险，随访横断面成像可能有助于指导进一步治疗。
