Endoscopy 2024; 56(11): 890-891
DOI: 10.1055/a-2343-5847
Letter to the editor

Reply to Saito et al.

1   Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
2   Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands
,
Pieter Jan F. de Jonge
1   Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
› Author Affiliations

We would like to thank Saito et al. for their interest in our manuscript [11]. Our findings align with the meta-analysis reported by Iwashita et al. [22], supporting long-term indwelling double-pigtail stents (DPSs) to reduce pancreatic fluid collection (PFC) recurrence. Whether leaving DPSs indwelling should be a prix fixe for all or à la carte requires balanced consideration.

For patients with disconnected pancreatic duct syndrome (DPDS), indwelling a DPS is beneficial. As the studies of both Sato et al. and ourselves confirm, DPDS is a risk factor for recurrent PFCs; however, our study’s retrospective nature and lack of standardized DPDS diagnosis mean that the total number of DPDS patients is unknown. Actively assessing pancreatic duct integrity using secretin-magnetic resonance cholangiopancreatography could be an interesting approach, although its sensitivity and accuracy for DPDS remain uncertain. The results of the currently running POLAR trial (Netherlands Trial Register: NL8123) are eagerly awaited.

We found leaving DPSs indwelling was relatively safe, with only one patient experiencing gastrointestinal perforation following DPS migration, which contrasts with the report of Yamauchi et al. who reported an 8% incidence of colonic perforation with long-term indwelling DPSs [33]. Despite the 26.1% pooled complication rate reported in the aforementioned meta-analysis, none of the 37 complications were gastrointestinal perforations [22]. Additionally, Gkolfiakis et al. reported no severe complications that could not be managed by simple removal of the DPS [44].

We suggest using DPSs over lumen-apposing metal stents (LAMSs) for initial drainage. The use of DPSs reduces procedural costs and eliminates the need for a gastroscopy to remove the LAMS and replace it with a DPS, although LAMS placement may reduce the procedural time without affecting outcomes [55].

The proposed randomized trial by Sato et al. is eagerly anticipated to provide definite answers. Until then, owing to the DPDS status often being unknown and the low risk of long-term DPS complications, we advocate for the use of indwelling DPSs in all patients with walled-off necrosis to reduce the risk of PFC recurrence.



Publication History

Article published online:
30 October 2024

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