Advanced Endoscopy Fellows Program | September 2022-Glessing

Glessing_Pancreatic CASE

Pdf Summary

This presentation discusses disconnected pancreatic duct syndrome (DPDS), which occurs when necrosis of a segment of the pancreas leads to a lack of continuity between the viable secreting pancreatic tissue and the gastrointestinal tract. This can result in recurrent pancreatic fluid collections, external pancreatic fistulae, and chronic abdominal pain. Historically, surgery has been the main treatment for DPDS, either through resection or internal drainage procedures. However, surgery in the setting of acute necrotizing pancreatitis can be challenging and associated with significant morbidity. Advances in therapeutic endoscopy have provided minimally invasive options for managing DPDS. <br /><br />The case presented describes a patient with a disrupted pancreatic duct who developed increasing abdominal pain. A CT sinogram showed a fistulous connection between a fluid collection in the left lower quadrant and the pancreatic body/tail. The next steps for treatment are not mentioned.<br /><br />The presentation concludes that EUS guided pancreatic duct access for reconnection may be an option for patients with duct disruption, but limited long-term follow-up data and a lack of dedicated therapeutic EUS access devices and wires are limitations. It suggests that this technique should be considered in select patients. No financial conflicts of interest were disclosed in relation to this content.

Keywords

disconnected pancreatic duct syndrome

necrosis

pancreas

gastrointestinal tract

chronic abdominal pain

surgery

therapeutic endoscopy

CT sinogram

fistulous connection

EUS guided pancreatic duct access