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Larsen M, Kozarek RA. Management of Disconnected Pancreatic Duct Syndrome. Curr Treat Options Gastroenterol. 2016;14(3):348-59doi: 10.1007/s11938-016-0098-7.
Larsen, M., & Kozarek, R. A. (2016). Management of Disconnected Pancreatic Duct Syndrome. Current treatment options in gastroenterology, 14(3), 348-59. https://doi.org/10.1007/s11938-016-0098-7
Larsen, Michael, and Kozarek, Richard A. "Management of Disconnected Pancreatic Duct Syndrome." Current treatment options in gastroenterology vol. 14,3 (2016): 348-59. doi: https://doi.org/10.1007/s11938-016-0098-7
Larsen M, Kozarek RA. Management of Disconnected Pancreatic Duct Syndrome. Curr Treat Options Gastroenterol. 2016 Sep;14(3):348-59. doi: 10.1007/s11938-016-0098-7. PMID: 27392638.
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Curr Treat Options Gastroenterol. 2016 Sep;14(3):348-59. doi: 10.1007/s11938-016-0098-7.

Management of Disconnected Pancreatic Duct Syndrome.

Current treatment options in gastroenterology

Michael Larsen, Richard A Kozarek

Affiliations

  1. Gastroenterology Division, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, C3-GAS, Seattle, WA, 98101, USA. [email protected].
  2. Virginia Mason Medical Center, 1100 Ninth Avenue, C3-GAS, Seattle, WA, 98101, USA. [email protected].
  3. Gastroenterology Division, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, C3-GAS, Seattle, WA, 98101, USA.

PMID: 27392638 DOI: 10.1007/s11938-016-0098-7

Abstract

OPINION STATEMENT: A disconnected pancreatic duct most commonly follows an episode of severe pancreatitis and walled-off necrosis (WON). When the latter is drained percutaneously, a pancreatic fistula connected to an upstream and disconnected duct is commonly seen. Transgastric drainage of WON with or without concomitant percutaneous drainage (dual drainage) will allow placement of two pigtail stents to drain the upstream duct and ultimately allows removal of percutaneous tubes and avoids the need for distal pancreatectomy. These stents should be left in place indefinitely. In patients referred with percutaneous drains and a disconnected pancreatic duct but without a concomitant fluid collection, a combined procedure, in which an interventional radiologist places a TIPS needle into the drain tract to puncture the stomach, allows the endoscopist access to dilate and stent the tract in a manner comparable to pseudocyst drainage. These stents should be left indefinitely, unless subsequent imaging demonstrates atrophy of the disconnected pancreatic tail.

Keywords: Disconnected duct syndrome; ERCP; EUS; Interventional radiology; Pancreatic fistula; Pancreatic necrosis; Pancreatitis; Walled-off necrosis

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