title: Transpapillary drainage of walled-off pancreatic necrosis - a single center experience.
abstract: BACKGROUND
  Walled-off pancreatic necrosis (WOPN) often coexists with disruption of the main pancreatic duct that manifests as a leak of contrast medium into the necrotic collection during endoscopic retrograde pancreatography.
  
  
  OBJECTIVE
  To assess the efficacy and safety of treatment of patients with symptomatic WOPN and disruption of the main pancreatic duct, who underwent endoscopic transpapillary drainage as the only access to the necrosis cavity.
  
  
  METHODS
  In 22 patients with symptomatic WOPN, active endoscopic transpapillary drainage was performed. During endoscopic retrograde pancreatography (ERP), partial disruption of the main pancreatic duct was observed in 14 patients and complete disruption in 8 patients. After the active drainage was finished, a transpapillary pancreatic stent was inserted into the main pancreatic duct, which was later exchanged after 6, 12 and 24 months or when no extravasation of contrast from the pancreatic duct was observed. The results of treatment and complications were compared retrospectively.
  
  
  RESULTS
  The mean duration of active drainage was 22 (range: 7-94) days. Complications of endotherapy occurred in 3/22 patients. The mean time of the main pancreatic duct stenting was 304 (range: 85-519) days. Success of endoscopic treatment of WOPN and pancreatic duct disruption was achieved in 20/22 patients. During a 1-year follow-up, recurrence of the collection was noted in 4/20 patients. Long-term success was achieved in 16/22 patients.
  
  
  CONCLUSIONS
  In patients with WOPN who cannot undergo transmural drainage when there is a communication between the necrotic collection and the main pancreatic duct, transpapillary access may be an effective and safe method of treatment.
authors: Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland.
authors: Marian
authors: M
authors: Smoczyński
authors: Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland.
authors: Mateusz
authors: M
authors: Jagielski
authors: Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland.
authors: Anna
authors: A
authors: Jabłońska
authors: Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland.
authors: Krystian
authors: K
authors: Adrych
keywords: acute pancreatitis; disconnected pancreatic duct syndrome; endoscopic drainage/debridement; transpapillary drainage/debridement; walled-off pancreatic necrosis