Abstract
BackgroundDisconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS.MethodsThe PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.ResultsThirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0–95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7–77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6–90.5) and 87.4% (95%-CI 81.2–91.8), respectively (P = 0.389).ConclusionsEndoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.
Highlights
Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF)
The total prevalence of walled-of necrosis (WON) and pseudocyst were 65.3% (560/857) and 34.7% (297/857) respectively in 16 studies reporting the type of PFC [3, 4, 8, 12, 20, 24, 28,29,30, 33, 36, 37, 39,40,41]
A specific etiology of DPDS was not reported in seven studies [8, 12, 26, 28,29,30,31]
Summary
Study selection The study was carried out according to the Systematic Reviews and Meta-analysis (PRISMA) guidelines [10]. The inclusion criteria were English studies which reported on complete duct disruption or DPDS in adults (> 18 years) following pancreatitis or trauma. Terminology and definitions DPDS was defined by the evidence of complete discontinuity of the MPD with specific diagnostic criteria outlined in each study and included the term complete duct disruption. Transmural drainage was defined as an endoscopic approach that involved formation of fistula between PFC and the gastrointestinal tract, usually the stomach or duodenum [1]. Metal stent was deployed and on follow-up procedure removed or replaced with double pig-tail stents for long-term drainage [3, 12, 13]. A subgroup analysis was performed for transmural and transpapillary drainage to compare rates of success
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