Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis
Abstract Background 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). This systematic review and pairwise meta-a...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-02-01
|
| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-021-01663-2 |
| _version_ | 1818574562861776896 |
|---|---|
| author | Eric Chong Chathura Bathiya Ratnayake Samantha Saikia Manu Nayar Kofi Oppong Jeremy J. French John A. Windsor Sanjay Pandanaboyana |
| author_facet | Eric Chong Chathura Bathiya Ratnayake Samantha Saikia Manu Nayar Kofi Oppong Jeremy J. French John A. Windsor Sanjay Pandanaboyana |
| author_sort | Eric Chong |
| collection | DOAJ |
| description | Abstract Background 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). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The 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. Results Thirty 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). Conclusions Endoscopic 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. |
| first_indexed | 2024-12-15T00:28:12Z |
| format | Article |
| id | doaj.art-d7d840e76e1145dd8db50ffa0b0de7ca |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-15T00:28:12Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-d7d840e76e1145dd8db50ffa0b0de7ca2022-12-21T22:42:06ZengBMCBMC Gastroenterology1471-230X2021-02-0121111210.1186/s12876-021-01663-2Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysisEric Chong0Chathura Bathiya Ratnayake1Samantha Saikia2Manu Nayar3Kofi Oppong4Jeremy J. French5John A. Windsor6Sanjay Pandanaboyana7Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of AucklandSurgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of AucklandDepartment of Radiology, Freeman HospitalDepartment of Gastroenterology, Freeman HospitalDepartment of Gastroenterology, Freeman HospitalHPB and Transplant Unit, Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman HospitalSurgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of AucklandHPB and Transplant Unit, Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman HospitalAbstract Background 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). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The 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. Results Thirty 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). Conclusions Endoscopic 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.https://doi.org/10.1186/s12876-021-01663-2Disconnected pancreatic ductPancreatic duct disruptionAcute necrotizing pancreatitisPancreatic fistula |
| spellingShingle | Eric Chong Chathura Bathiya Ratnayake Samantha Saikia Manu Nayar Kofi Oppong Jeremy J. French John A. Windsor Sanjay Pandanaboyana Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis BMC Gastroenterology Disconnected pancreatic duct Pancreatic duct disruption Acute necrotizing pancreatitis Pancreatic fistula |
| title | Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis |
| title_full | Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis |
| title_fullStr | Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis |
| title_full_unstemmed | Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis |
| title_short | Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis |
| title_sort | endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome a systematic review and meta analysis |
| topic | Disconnected pancreatic duct Pancreatic duct disruption Acute necrotizing pancreatitis Pancreatic fistula |
| url | https://doi.org/10.1186/s12876-021-01663-2 |
| work_keys_str_mv | AT ericchong endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis AT chathurabathiyaratnayake endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis AT samanthasaikia endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis AT manunayar endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis AT kofioppong endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis AT jeremyjfrench endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis AT johnawindsor endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis AT sanjaypandanaboyana endoscopictransmuraldrainageisassociatedwithimprovedoutcomesindisconnectedpancreaticductsyndromeasystematicreviewandmetaanalysis |