Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of long-term follow-up.
BACKGROUND
Limited published data exist that address the incidence and outcomes of patients with complete pancreatic-duct disruption.


OBJECTIVE
Report on a single-center experience with this entity that emphasizes the feasibility of endoscopic therapy and long-term outcomes.


METHODS
Retrospective analysis.


METHODS
Tertiary-care medical center (Portland, Maine).


METHODS
A total of 189 patients with pancreatic-fluid collections and/or pancreatic fistulas were retrospectively evaluated for the presence of a disconnected pancreatic tail. Patients meeting the definition of disconnected pancreatic tail syndrome (DPTS) with a minimum of 6 months' follow-up were analyzed.


RESULTS
Thirty of 189 patients (16%) met criteria for DPTS. Thirty-six drainage procedures were performed on 29 patients (mean 1.2 procedures per patient). In 22 of 29 patients (76%), the initial drainage procedure was successful. However, recurrent fluid collection(s) developed in 11 of 22 patients (50%) and was seen in those treated surgically and endoscopically. Disruption in the tail (n = 3) was uncommon but invariably required no surgical intervention. The median follow-up was 38 months (range 3-94 months). Diabetes mellitus developed in 16 of 30 patients (53%); 15 of 30 patients (50%) had left-sided portal hypertension; 16 of 30 patients (53%) continue in active medical or surgical follow-up for recurrent symptoms attributable to the disconnected pancreatic tail.


CONCLUSIONS
Of patients with a pancreatic-fluid collection and/or fistula, 16% will also have a disconnected pancreatic tail. Endoscopic and surgical drainage techniques are typically initially successful, but both suffer from a high rate of recurrence in the setting of DPTS. The majority of patients will require long-term follow-up because of complications and/or ongoing symptoms.
Lawrence
Christopher
C
Maine Medical Center, Portland, Maine, USA.
Howell
Douglas A
DA
Stefan
Andreas M
AM
Conklin
Donald E
DE
Lukens
Frank J
FJ
Martin
Ronald F
RF
Landes
Andrew
A
Benz
Becky
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D012189:Retrospective Studies; D013577:Syndrome; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome