Author(s): Lawrence C, Howell DA, Stefan AM, Conklin DE, Lukens FJ,
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Abstract BACKGROUND: Limited published data exist that address the incidence and outcomes of patients with complete pancreatic-duct disruption. OBJECTIVE: Report on a single-center experience with this entity that emphasizes the feasibility of endoscopic therapy and long-term outcomes. DESIGN: Retrospective analysis. SETTING: Tertiary-care medical center (Portland, Maine). PATIENTS: A total of 189 patients with pancreatic-fluid collections and/or pancreatic fistulas were retrospectively evaluated for the presence of a disconnected pancreatic tail. Patients meeting the definition of disconnected pancreatic tail syndrome (DPTS) with a minimum of 6 months' follow-up were analyzed. RESULTS: Thirty of 189 patients (16\%) met criteria for DPTS. Thirty-six drainage procedures were performed on 29 patients (mean 1.2 procedures per patient). In 22 of 29 patients (76\%), the initial drainage procedure was successful. However, recurrent fluid collection(s) developed in 11 of 22 patients (50\%) and was seen in those treated surgically and endoscopically. Disruption in the tail (n = 3) was uncommon but invariably required no surgical intervention. The median follow-up was 38 months (range 3-94 months). Diabetes mellitus developed in 16 of 30 patients (53\%); 15 of 30 patients (50\%) had left-sided portal hypertension; 16 of 30 patients (53\%) continue in active medical or surgical follow-up for recurrent symptoms attributable to the disconnected pancreatic tail. CONCLUSIONS: Of patients with a pancreatic-fluid collection and/or fistula, 16\% will also have a disconnected pancreatic tail. Endoscopic and surgical drainage techniques are typically initially successful, but both suffer from a high rate of recurrence in the setting of DPTS. The majority of patients will require long-term follow-up because of complications and/or ongoing symptoms.
This article was published in Gastrointest Endosc
and referenced in Pancreatic Disorders & Therapy