INDWELLING DOUBLE-PIGTAIL PLASTIC STENTS FOR THE TREATMENT OF DISCONNECTED PANCREATIC DUCT SYNDROME-ASSOCIATED PERIPANCREATIC FLUID COLLECTIONS: LONG-TERM SAFETY AND EFFICACY

Aims Transmural indwelling double-pigtail stents (DPS) are recommended for patients with disconnected pancreatic duct syndrome (DPDS) and peripancreatic fluid collections (PFC). Long-term safety and efficacy of indwelling DPS placement were evaluated.

Methods Medical files of patients treated with transmural DPS for DPDS-associated PFC (walled-off necrosis or pseudocysts due to acute or chronic pancreatitis) and minimum follow-up of 48 months were reviewed. Overall, early (< 28 days) and late complication rates were calculated. Long-term outcomes (efficacy and collection recurrence) were assessed.

Results From 2002 to 2014, 116 patients [86 (74.1%) men; age 48.1±15 years; 57 (49.1%) chronic pancreatitis] with complete pancreatic duct rupture confirmed by MRCP or ERCP were identified. They underwent 175 transmural drainages (150 (85.7%) transgastric access; 2 DPS deployed in 71 (40.5%) of the cases). Sixty-nine (59.4%) of the initial drained collections were pseudocysts (94.2±50mm) and the main drainage indication was infection (55/116; 47.4%). Mean follow-up was 80.6±34.4 months.Per intervention complication rates were 20.5% (36/175), 11.4% (20/175) and 9.1% (16/178) for overall, early and late complications, respectively. Among early complications, 15/20 occurred peri-interventionally (bleeding and pneumoperitoneum) and 8 required further intervention or transfusion. Among late complications (stent-induced ulcer, bleeding, organ compression and abscess) only 2/16 required additional intervention other than stent removal. No death related to the procedure occurred. In per patient analysis, the complication rate was 1 per 21.6 patients-years of follow-up and 1 per 48.7 patients-years of follow-up regarding late complications. Migration (spontaneously or intended) of initial DPS occurred in 86/116 (74.1%) patients (42±36.7 months). Early migration (< 6, < 12 and < 24 months) was associated with an increased risk of collection recurrence (p≤0.02). At the end of follow-up endoscopic treatment was considered unsuccessful in 6/116 (0.05%) patients.

Conclusions Indwelling DPS for DPDS are associated with a low risk of long-term complications and a lower risk of PFC recurrence.