Pancreatic Duct Disruption Treated With Endoscopic Transpapillary Pancreatic Duct Stent Placement

; ; , Brigham and Women's Hospital, Boston, Massachusetts


November 13, 2001

In This Article


Pancreatic duct disruption is an uncommon condition resulting from pancreatitis[1,2] or pancreatic trauma.[3] The disruption may manifest as ascites,[4] a pancreatic fluid collection,[5] or a fistula communicating with the skin or an internal organ.[6]

Conservative therapies such as TPN,[7] somatostatin analogues,[7,8] and pancreatic enzyme replacement[9] have limited use, and persistent PD disruptions require intervention. A multidisciplinary approach involving endoscopists, interventional radiologists, and surgeons is optimal. Endoscopic techniques include PD stent placement,[10,11] as described in this case, as well as internal drainage of fluid collections in the form of a cystoduodenostomy or cystogastrostomy.[12] Percutaneous drainage of fluid collections can also be performed by interventional radiology.[13,14] Surgical options include internal and external drainage of fluid collections and pancreatic surgery.[15]

Several case series have shown PD stent placement to be an effective therapy in resolving PD disruption and its sequelae.[2,3,4,5,10,11,16] PD disruption resolution is associated with a bridging stent position and a duration of stent therapy greater than 2 weeks.[17] Furthermore, complete disruption of the main PD -- the disconnected duct -- is associated with therapeutic failure.[10] In this setting, the PD proximal to the disruption cannot be cannulated and a disconnected section of pancreas continues to secrete pancreatic fluid into the area of disruption. Otherwise, several retrospective series and one prospective study have not shown any significant predictors of outcome following stent placement.[2,3,4,5,11,16] There have been no controlled trials comparing 2 or more interventions in this group of patients.

Complications of PD stent placement have been well described, including stent occlusion, stent migration, pancreatitis, and infection.[18,19,20] There have also been concerns of stent-induced morphologic changes in the PD and parenchyma that mimic the abnormalities seen in chronic pancreatitis. [21] The majority of these resolve and no clinical ramification has been recognized.

In conclusion, then, PD stent insertion is a safe and effective treatment for PD disruption. Successful outcome is associated with a bridging stent position and duration of stent therapy longer than 2 weeks.


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