Diagnostic and therapeutic role of endoscopic retrograde pancreatography in the management of traumatic pancreatic duct injury patients: Single center experience for 34 years.
BACKGROUND
Traumatic pancreatic injuries are rare and present diagnostic and therapeutic difficulties. We evaluated the usefulness of endoscopic retrograde pancreatography and transpapillary pancreatic stent in the diagnosis and treatment of pancreatic trauma patients.


METHODS
We reviewed medical records of 83 pancreas trauma patients who underwent endoscopic retrograde pancreatography for the suspicion of pancreas duct injury between January 1983 and December 2016. Patient notes, radiologic findings, laboratory investigations, operative records, and endoscopic retrograde pancreatography reports were reviewed.


RESULTS
Pre-endoscopic retrograde pancreatography abdominal computed tomography was performed in 52 patients. Twenty-seven patients of them were diagnosed with a major pancreatic duct injury by subsequent endoscopic retrograde pancreatography. Eleven major pancreatic duct injuries (40.7%) were missed by the pre-endoscopic retrograde pancreatography abdominal CT. Major pancreatic duct injury was confirmed by endoscopic retrograde pancreatography in 43 patients. These 43 major pancreatic duct injury patients were classified into the Operative (n = 21), Stent (n = 15), and Conservative (n = 7) groups according to the first treatment modality which was chosen by attending surgeon. Age, initial white blood cell count, initial serum amylase, associated injury, and major pancreatic duct injury site were similar among groups, while the rate of parenchymal leakage (Dye leakage confined to pancreatic capsule) on endoscopic retrograde pancreatography findings differed. Parenchymal leakage was most common in the Conservative group. Pancreas related mortality occurred in 1 (4.76%) Operative group, 2 (13.33%) Stent group, and 0 (0%) Conservative group. Pancreas related complication occurred in 16 (76.19%) Operative group, 10 (66.67%), Stent group and 5 (71.43%) Conservative group. There were no statistically significant differences in the occurrence rate of pancreas related complications and mortalities among three groups.


CONCLUSIONS
Endoscopic retrograde pancreatography helps clinicians choose a treatment modality for major pancreatic duct injury since it provides information about the precise condition of the major pancreatic duct injury. Endoscopic retrograde pancreatography with transpapillary pancreatic stenting also shows promise as a substitute for laparotomy or pancreatic resection in selected patients.
Department of Surgery, Yonsei University, Wonju College of Medicine, Republic of Korea. Electronic address: sykimvs@yonsei.ac.kr.
Seongyup
S
Kim
Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Republic of Korea. Electronic address: Jawkim96@yonsei.ac.kr.
Jae Woo
JW
Kim
Department of Surgery, Yonsei University, Wonju College of Medicine, Republic of Korea. Electronic address: surgery4trauma@yonsei.ac.kr.
Pil Young
PY
Jung
Department of Surgery, Yonsei University, Wonju College of Medicine, Republic of Korea. Electronic address: hemocontin79@gmail.com.
Hye Youn
HY
Kwon
Department of Surgery, Yonsei University, Wonju College of Medicine, Republic of Korea. Electronic address: simong3@yonsei.ac.kr.
Hongjin
H
Shim
Department of Surgery, Yonsei University, Wonju College of Medicine, Republic of Korea. Electronic address: gomdolly@yonsei.ac.kr.
Ji Young
JY
Jang
Department of Surgery, Yonsei University, Wonju College of Medicine, Republic of Korea. Electronic address: bksgs@yonsei.ac.kr.
Keum Seok
KS
Bae
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000293:injuries*; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods
Endoscopic retrograde pancreatography; Pancreas; Pancreatic stent; Trauma