Endoscopy 2020; 52(S 01): S124
DOI: 10.1055/s-0040-1704381
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 EUS- guided therapy: From training to complications Liffey Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

DIAGNOSIS AND TREATMENT OF PANCREATIC DUCT DISRUPTION OR DISCONNECTION: AN INTERNATIONAL EXPERT SURVEY AND CASE VIGNETTE STUDY

Dutch Pancreatitis Study Group
HC Timmerhuis
1   St. Antonius Hospital, Surgery, Nieuwegein, Netherlands
,
L Boxhoorn
2   Amsterdam UMC, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
MG Besselink
3   Amsterdam UMC, Surgery, Amsterdam, Netherlands
,
TL Bollen
4   St. Antonius Hospital, Radiology, Nieuwegein, Netherlands
,
MJ Bruno
5   Erasmus MC University Medical Center, Gastroenterology & Hepatology, Rotterdam, Netherlands
,
B Joseph Elmunzer
6   Medical University of South Carolina, Gastroenterology & Hepatology, Charleston, USA
,
P Fockens
2   Amsterdam UMC, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
KD Horvath
7   Medical University of Washington, Surgery, Seattle, USA
,
RC Verdonk
8   St. Antonius Hospital, Gastroenterology, Nieuwegein, Netherlands
,
HC van Santvoort
1   St. Antonius Hospital, Surgery, Nieuwegein, Netherlands
,
RP Voermans
2   Amsterdam UMC, Gastroenterology & Hepatology, Amsterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims A disrupted or disconnected pancreatic duct is an often overlooked and potentially severe complication of necrotizing pancreatitis. We aimed to evaluate current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in patients with necrotizing pancreatitis to assist in developing future guidelines.

Methods An online survey consisting of 6 general questions and 3 case vignettes was sent to 124 international expert pancreatologists. Experts were selected based on publications on pancreatic duct disruption and disconnection in the last 5 years, participation in the development of IAP/APA and ESGE guidelines on acute pancreatitis or the Dutch Pancreatitis Expert Panel.

Results The response rate was 35%; 20 surgeons (47%), 19 gastroenterologists (44%) and 4 radiologists (9%) responded. Of the respondents, 38 (88%) had over 10 years of experience in treating patients with necrotizing pancreatitis. Seventeen respondents (40%) always evaluate pancreatic duct integrity in patients with necrotizing pancreatitis, 12 (28%) usually, 11 (25%) sometimes and 3 respondents (7%) never. Thirty-five respondents (81%) prefer evaluation of a disrupted or disconnected pancreatic duct by MRI/MRCP over other imaging modalities. Endoscopic transluminal drainage is the preferred intervention in patients with infected necrotizing pancreatitis and a disrupted duct (37 respondents, 86%) or disconnected duct (39 respondents, 91%). When drained endoscopically,15 respondents (35%) would prefer plastic pigtails, 21 (49%) lumen-apposing metal stents and 7 (16%) no preference. In patients with persistent percutaneous drain production and duct disruption, 15 respondents (35%) would perform EUS-guided drainage to internalize the external drain, 13 (30%) endoscopic transpapillary drainage and 3 respondents (7%) upfront surgery.

Conclusions This international survey demonstrated that MRI/MRCP is the preferred diagnostic modality and endoscopic transluminal drainage the preferred intervention for pancreatic duct disruption or disconnection. Consensus is lacking regarding when to look for a disrupted duct and regarding the treatment of patients with persistent percutaneous drain production.