Gastrointestinal endoscopy · 2008
Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases.
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Pelaez-Luna Mario, Vege Santhi Swaroop, Petersen Bret T, Chari Suresh T, Clain Jonathan E, Levy Michael J, Pearson Randal K, Topazian Mark D, Farnell Michael B, Kendrick Michael L, Baron Todd H
Аннотация
BACKGROUND: Information regarding the natural history, clinical characteristics, and outcomes of disconnected pancreatic duct syndrome (DPDS) is limited.
OBJECTIVE: To describe clinical characteristics and outcomes of DPDS.
DESIGN: A retrospective review of the Mayo Clinic endoscopy and hospital service database.
SETTING: Tertiary-referral center.
PATIENTS: We identified 31 DPDS cases from 1999 to 2006.
INTERVENTIONS: Endoscopic drainage of pancreatic-fluid collections.
MAIN OUTCOME MEASUREMENTS: The relationship between demographic and clinical data with endoscopic treatment and clinical outcomes in DPDS cases.
RESULTS: The median patient age was 53 years (range 20-83 years); 48% were men. The most common etiology of acute pancreatitis (AP) was biliary (55%) followed by idiopathic (27%). The median interval between the diagnoses of AP and DPDS was 56 days (range 3-251 days); the median follow-up after the last ERCP or surgical procedure was 7 months (range 0-90 months). The DPDS location included the following: pancreas head 6%, neck 58%, body 26%, and tail 10%. Twenty-six patients had initial endoscopic treatment (19 had long-term improvement; 7 failed treatment and required surgery) and 5 underwent immediate surgery. Mortality was 0%; 26% developed chronic pancreatitis (CP) and 16% diabetes mellitus (DM); 10% resolved completely, 45% had smaller fluid collections, and 26% patients were lost to follow-up. No relationship between demographic and clinical data with endoscopic and clinical outcomes was found.
CONCLUSIONS: Endoscopic treatment temporarily improved DPDS, with a failure rate of 23%. Immediate surgery was not required in all cases. CP and/or pancreatic atrophy occurred relatively shortly after the DPDS diagnosis in 26% and DM in 16% of cases. DPDS did not lead to mortality. Early surgery may be considered after initially stabilizing the fluid collection with endoscopic therapy.
OBJECTIVE: To describe clinical characteristics and outcomes of DPDS.
DESIGN: A retrospective review of the Mayo Clinic endoscopy and hospital service database.
SETTING: Tertiary-referral center.
PATIENTS: We identified 31 DPDS cases from 1999 to 2006.
INTERVENTIONS: Endoscopic drainage of pancreatic-fluid collections.
MAIN OUTCOME MEASUREMENTS: The relationship between demographic and clinical data with endoscopic treatment and clinical outcomes in DPDS cases.
RESULTS: The median patient age was 53 years (range 20-83 years); 48% were men. The most common etiology of acute pancreatitis (AP) was biliary (55%) followed by idiopathic (27%). The median interval between the diagnoses of AP and DPDS was 56 days (range 3-251 days); the median follow-up after the last ERCP or surgical procedure was 7 months (range 0-90 months). The DPDS location included the following: pancreas head 6%, neck 58%, body 26%, and tail 10%. Twenty-six patients had initial endoscopic treatment (19 had long-term improvement; 7 failed treatment and required surgery) and 5 underwent immediate surgery. Mortality was 0%; 26% developed chronic pancreatitis (CP) and 16% diabetes mellitus (DM); 10% resolved completely, 45% had smaller fluid collections, and 26% patients were lost to follow-up. No relationship between demographic and clinical data with endoscopic and clinical outcomes was found.
CONCLUSIONS: Endoscopic treatment temporarily improved DPDS, with a failure rate of 23%. Immediate surgery was not required in all cases. CP and/or pancreatic atrophy occurred relatively shortly after the DPDS diagnosis in 26% and DM in 16% of cases. DPDS did not lead to mortality. Early surgery may be considered after initially stabilizing the fluid collection with endoscopic therapy.
Предметные рубрики MeSH
Acute DiseaseAdultAgedAged, 80 and overAnalysis of VarianceCholangiopancreatography, Endoscopic RetrogradeCohort StudiesDiagnostic ImagingDrainageEndoscopyFemaleFollow-Up StudiesHumansLaparotomyMaleMiddle AgedPancreatic DuctsPancreatic FistulaPancreatic PseudocystPancreatitisRetrospective StudiesRisk AssessmentSeverity of Illness IndexSurvival RateSyndromeTomography, X-Ray ComputedTreatment Outcome