Endoscopic Retrograde Cholangiopancreatography Combined with Percutaneous Drainage in Treating Disconnected Pancreatic Duct Syndrome

Summary

The combination of ERCP and PCD can safely and effectively treat DPDS with a minimally invasive procedure. This study focuses on treating DPDS with ERCP and PCD, aiming to increase the surgical success rate through the use of the double guidewire technique and localization with methylene blue staining.

Abstract

Disconnected pancreatic duct syndrome (DPDS), resulting from pancreatic injury or disease, is increasingly prevalent and poses significant challenges in clinical management due to its associated complications: leakage of pancreatic secretions, inflammation, and infection. DPDS is characterized by the leakage of pancreatic secretions into the surrounding tissues; this leakage often results from trauma, postoperative complications, or chronic pancreatitis. The resultant complications can significantly impair a patient's quality of life, necessitating effective and innovative treatment approaches. Although traditional management strategies for DPDS include surgical repair and conservative management, these strategies are often associated with high morbidity and complications. The limitations of these conventional approaches highlight the urgent need for alternative treatment modalities that reduce both surgical invasiveness and the risks associated with surgical repair. Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established technique for diagnosing and treating conditions related to the biliary and pancreatic ducts. Given these challenges, exploring new diagnostic and therapeutic techniques is critical. Recent literature suggests that the combination of ERCP with percutaneous drainage (PCD) techniques may offer a promising alternative, potentially improving outcomes for patients suffering from DPDS. This study aims to investigate the efficacy and safety of ERCP combined with percutaneous drainage in the treatment of DPDS, providing novel insights into its clinical application.

Introduction

DPDS was first described by Kozarek¹. The most common underlying cause of disconnected pancreatic duct syndrome (DPDS) is acute necrotizing pancreatitis. The incidence of DPDS in patients with necrotizing pancreatitis ranges from 16.0% to 46.3%^2,3. Clinical manifestations include ongoing pancreatic duct leaks; episodes of recurrent obstructive pancreatitis; recurrent fluid collections around the pancreas, including pseudocysts; and impairment of pancreatic exocrine and endocrine functions. Additionally, patients may develop pancreatic ascites or pancreatic pleural effusion; pseudoaneury....

Protocol

This study was approved by the Ethics Committee of the Fifth Affiliated Hospital of Southern Medical University. Written informed consent was obtained from the patient before the procedure.

1. Patient selection

1. Confirm the indication for surgery. Here, the PCD was draining about 300 mL of pancreatic fluid each day after the initial surgery.

2. Informed consent

1. Discuss the surgical procedure, risks, benefits, and alternatives with the patient, and ensure that informed consent is obtained.

3. Preoperative worku....

Results

From March 2023 to May 2025, ERCP + PCD was performed on 2 patients in our department. The key to a successful surgery lies in whether the junction between the MPD and the cyst can be successfully breached. In one patient, the endoscopic guidewire was successfully navigated into the cyst cavity after several attempts during treatment. However, in this patient of this study, despite several attempts with the endoscopic guidewire, it could not enter the cyst cavity. The cyst wall junction was marked with methylene blue, an.......

Discussion

Currently, endoscopic treatment is a popular option for treating patients with DPDS, which mainly includes ERCP, EUS, ERCP with PCD, and ERCP with EUS. According to different drainage methods, it is mainly divided into transpapillary drainage and transmural drainage.Transpapillary drainage is physiologic and more attractive. Compared with transwall drainage, transpapillary drainage does not require creating an alternative nonanatomical route of drainage. ERCP combined with PCD is one of the methods of transpapillary drai.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Balloon catheter	Boston Scientific Corp.	M00558610	Dilate the papilla
Bile duct stent	Boston Scientific Corp.	M00539220	Biliary drainage
Catheter and guidewire	Boston Scientific Corp.	M00583100	Used for cannulation of MPD and bile duct.
Cholangiopancreatoscopy	Scivita Medical Corp.	SCV-P-02	Explore MPD
Duodenoscope	Sonoscape Medical Corp.	ED-5GT	Used for ERCP
Electronic bile duct scope	Scivita Medical Corp.	SCC-BA2	Explore DPDS cavity
Nasal pancreatic duct catheter	Boston Scientific Corp.	M00540140	Pancreatic duct drainage
Pancreatic duct  stent (10 Fr, 12 cm)	Olympus Corporation	PBD-234-1012	Pancreatic duct drainage
Pancreatic duct stent (7 Fr, 10 cm)	Olympus Corporation	PBD-234-0710	Pancreatic duct drainage
PCD tube	Jinan Zhongkangshun Medical Devices Co.,Ltd.	C type Fr18	DPDS cavity drainage
Sheath	Jinan Zhongkangshun Medical Devices Co.,Ltd.	A type Fr18	Dilation of the sinus and rupture of the DPDS sac wall
Stone retrieval basket	Precision medical instruments	PNRC-2040-D-W	Break the DPDS capsule wall
Zebra guidewire	Jinan Zhongkangshun Medical Devices Co.,Ltd.	D4 type 0.032	Guided choledochoscope and DPDS cyst wall rupture