title: Endotherapy is effective for pancreatic ductal disruption: A dual center experience.
abstract: OBJECTIVE
  Pancreatic duct (PD) disruptions occur as a result of different etiologies and can be managed medically, endoscopically, or surgically. The aim of this study was to provide an evaluation on the efficacy of endotherapy for treatment of PD disruption in a large cohort of patients and identify factors that predict successful treatment outcome.
  
  
  METHODS
  We retrospectively evaluated consecutive patients who underwent endoscopic retrograde pancreatography (ERP) for transpapillary pancreatic stent placement for PD disruption from 2008 to 2013 at two tertiary referral institutions. PD disruption was defined as extravasation of contrast from the pancreatic duct as seen on ERP. Therapeutic success was defined by resolution of PD leak on ERP, clinical, and/or imaging evaluation.
  
  
  RESULTS
  We evaluated 107 patients (58% male, mean age 53 years) with PD disruption. Etiologies of PD disruption were acute pancreatitis (36%), post-operative (31%), chronic pancreatitis (29%), and trauma (4%). PD disruption was successfully bridged by a stent in 45 (44%) patients. Two patients developed post-sphincterotomy bleeding, two had stent migration, and two patients died as a result of post-ERP related complications. Placement of a PD stent was successful in 103/107 (96%) patients. Therapeutic success was achieved in 80/107 (75%) patients. Non-acute pancreatitis etiologies and absence of complete duct disruption were independent predictors of therapeutic success.
  
  
  CONCLUSIONS
  Endoscopic therapy using a transpapillary stent for PD disruption is safe and effective. Absence of complete duct disruption and non-AP etiologies determine a favorable endoscopic outcome.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Das
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: papachri@pitt.edu.
authors.forename: Georgios I
authors.initials: GI
authors.lastname: Papachristou
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Easler
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chennat
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Malin
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Herman
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Sobia N
authors.initials: SN
authors.lastname: Laique
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Umar
authors.initials: U
authors.lastname: Hayat
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Yinn Shaung
authors.initials: YS
authors.lastname: Ooi
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Rabinovitz
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000293:injuries* / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications; D014947:Wounds and Injuries / Q000150:complications
keywords: Endoscopic retrograde cholangiopancreatography; Pancreatic duct stent; Pancreatic ducts; Pancreatic fistula; Pancreatic pseudocyst; Pancreatitis