title: Disrupted pancreatic duct treated with a combination of endoscopic cystoduodenostomy and pancreatic duct fistualization through a pseudocyst wall using a lumen-apposing metal stent.
abstract: Management of disconnected pancreatic duct syndrome is complex and is increasingly approached using emerging endoscopic techniques. Herein, we present a case of recurrent pancreatitis in an elderly woman complicated by pseudocyst formation and complete pancreatic duct disruption. Her condition was treated with a novel combination of transpapillary stenting and cystduodenostomy in which a pancreatic duct stent was placed into an opening in the pseudocyst wall through a lumen-apposing metal stent. This allowed for effective drainage into the gastrointestinal tract and resolution of duct disruption. Post-procedure, the patient has had recovery of nutritional status and no further recurrence of pancreatic fluid collection. Endoscopic approaches to complete pancreatic duct disruption represent a viable and less invasive alternative to surgical management in selected cases.
authors.affiliation: Boston University Medical Center, Boston, USA.|Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: Robert M
authors.identifier: http://orcid.org/0000-0003-4593-7684
authors.initials: RM
authors.lastname: Wilechansky
authors.affiliation: Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian-Columbia University Medical Center, New York, USA.
authors.forename: Ali S
authors.identifier: http://orcid.org/0000-0002-9327-7783
authors.initials: AS
authors.lastname: Khan
authors.affiliation: Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian-Columbia University Medical Center, New York, USA.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D004385:Duodenostomy; D005260:Female; D006801:Humans; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Interventional endoscopy