title: Multimodality endoscopic treatment of pancreatic duct disruption with stenting and pseudocyst drainage: how efficacious is it?
abstract: BACKGROUND
  Few studies have described the role of multimodality therapy and the complexity of endoscopic management of pancreatic duct disruption. Our study aim was to analyse and confirm factors associated with the resolution of pancreatic duct disruption.
  
  
  METHODS
  Over 6 years, retrospective data on patients with pancreatic duct disruption managed endoscopically were retrieved. Success was defined as resolution of the pancreatic duct disruption at 12 months. Logistic regression analysis was performed to determine factors associated with resolution.
  
  
  RESULTS
  113 patients (78 male) with a mean age 51.3 year were included. Resolution of the pancreatic duct leak occurred in 80 cases (70.2%). 72 cases received transpapillary pancreatic duct stents, with 51 demonstrating resolution of pancreatic duct leak (71%) cystenterostomy was performed in 68 patients with 51 resolved (75%). In partial duct disruptions, pancreatic duct stenting combined with endoscopic drainage of fluid collections resulted in an increased rate of resolution (80%) compared to complete disruptions treated in a similar manner (57%). In complete pancreatic ductal disruptions, transpapillary pancreatic duct stenting had no additional benefit (9/17, 52.9%) compared to cystenterostomy or percutaneous drainage alone (24/34, 70.6%; P=0.61).
  
  
  CONCLUSIONS
  Pancreatic duct disruptions require multimodality treatment, addressing not only the integrity of the pancreatic duct but also any fluid collections associated. Partial ductal disruption should be managed by a bridging stent.
authors.affiliation: Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Shrode
authors.forename: Patrick
authors.initials: P
authors.lastname: Macdonough
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.forename: Bryan
authors.initials: B
authors.lastname: Sauer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ku
authors.forename: Kristi
authors.initials: K
authors.lastname: Ellen
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult