All but one failure in the EGD group was secondary to a lack of a bulge seen in the gastrointestinal (GI) tract. Park et al. published the results of another randomized trial which showed similar results with eight patients with no bulge crossing over to successful EUS drainage, with all patients in the study having eventual successful drainage. In a study published by Fockens et al.,
the use of EUS changed management in 37.5% of pseudocyst drainages because of a multitude of unexpected findings. If there is any doubt as to whether a fluid collection represents a pseudocyst or WOPN, EUS can be particularly helpful at identifying selleck chemical whether or not necrotic debris is present within the collection. Overall results suggest that if a bulge is seen in the GI tract, then drainage can be performed with or without EUS while patients without a visible bulge should receive EUS drainage. In summary, endoscopic treatment of pancreatic pseudocysts selleck chemicals appears to be effective, with a 94% initial success rate, 20% complication rate, and a 90% cyst resolution rate. Recurrences approximate 16% and procedural mortality is less than 1%. Because of the risk of adverse events, endoscopic drainage is best done in settings with significant experience and a multidisciplinary team. Alternative drainage options include surgery or percutaneous drainage. Care must be taken to ensure that a collection does not
represent WOPN before planning simple transmural drainage. Disconnected duct syndrome is a pancreatic duct leak with a complete transection of the main pancreatic duct resulting in an isolated segment of the proximal (tail) portion of the pancreas. This generally occurs as a result of severe acute pancreatitis with pancreatic necrosis and can be seen in up to 50% of these patients. This results in the entire upstream portion of the pancreas being isolated and not in communication with the papilla. This isolated segment of the pancreas will continue to produce its exocrine pancreatic juices which will be secreted
freely into the abdominal cavity resulting in a significant fistula. This type of fistula is not amenable to transpapillary stenting. The isolated portion of the pancreas cannot be reached from the papilla and therefore the leak this website cannot be bridged endoscopically. Historically, DDS has required surgical excision of the isolated tail segment of the pancreas. However, several endoscopic and interventional alternatives have been developed, although treatment success remains variable. Endoscopic management of DDS has been described in several series and reviews.[2, 38, 52, 58, 60, 61] This method employs transmural drainage of fluid collections as described in the previous section for treatment of pseudocysts; however, the transmural stents are left in place indefinitely. Leaving the transmural stents in place creates an outlet for the pancreatic juice from the isolated tail segment of the pancreas.