Short-term and long-term outcomes of a disruption and disconnection of the pancreatic duct in necrotizing pancreatitis: a multicenter cohort study in 896 patients

Timmerhuis, H.C.; Dijk, S.M. van; Hollemans, R.A.; Weiland, C.J.S.; Umans, D.S.; Boxhoorn, L.; ... ; Dutch Panvreatitis Study Grp (2023)

Article / Letter to editor

INTRODUCTION: Necrotizing pancreatitis may result in a disrupted or disconnected pancreatic duct (DPD) with the potential for long-lasting negative impact on a patient's clinical outcome. There is a lack of detailed data on the full clinical spectrum of DPD, which is critical for the development of better diagnostic and treatment strategies. METHODS: We performed a long-term post hoc analysis of a prospectively collected nationwide cohort of 896 patients with necrotizing pancreatitis (2005-2015). The median follow-up after hospital admission was 75 months (P25-P75: 41-151). Clinical outcomes of patients with and without DPD were compared using regression analyses, adjusted for potential confounders. Predictive features for DPD were explored. RESULTS:  DPD was confirmed in 243 (27%) of the 896 patients and resulted in worse clinical outcomes during both the patient's initial admission and follow-up. During hospital admission, DPD was associated with an increased rate of new-onset intensive care unit admission (adjusted odds ratio [aOR] 2.52; 95% confidence interval [CI] 1.62-3.93), new-onset organ failure (aOR 2.26; 95% CI 1.45-3.55), infected necrosis (aOR 4.63; 95% CI 2.87-7.64), and pancreatic interventions (aOR 7.55; 95% CI 4.23-13.96). During long-term follow-up, DPD increased the risk of pancreatic intervention (aOR 9.71; 95% CI 5.37-18.30), recurrent pancreatitis (aOR 2.08; 95% CI 1.32-3.29), chronic pancreatitis (aOR 2.73; 95% CI 1.47-5.15), and endocrine pancreatic insufficiency (aOR 1.63; 95% CI 1.05-2.53). Central or subtotal pancreatic necrosis on computed tomography (OR 9.49; 95% CI 6.31-14.29) and a high level of serum C-reactive protein in the first 48 hours after admission (per 10-point increase, OR 1.02; 95% CI 1.00-1.03) were identified as independent predictors for developing DPD. DISCUSSION:  At least 1 of every 4 patients with necrotizing pancreatitis experience DPD, which is associated with detrimental, short-term and long-term interventions, and complications. Central and subtotal pancreatic necrosis and high levels of serum C-reactive protein in the first 48 hours are independent predictors for DPD.

• disconnected pancreatic duct syndrome
• pancreatic duct leak
• pancreatic necrosis

• All authors: Timmerhuis, H.C.; Dijk, S.M. van; Hollemans, R.A.; Weiland, C.J.S.; Umans, D.S.; Boxhoorn, L.; Hallensleben, N.H.; Sluijs, R. van der; Brouwer, L.; Duijvendijk, P. van; Kager, L.; Kuiken, S.; Poley, J.W.; Ridder, R. de; Romkens, T.E.H.; Quispel, R.; Schwartz, M.P.; Tan, A.C.I.T.L.; Venneman, N.G.; Vleggaar, F.P.; Wanrooij, R.L.J. van; Witteman, B.J.; Geenen, E.J. van; Molenaar, I.Q.; Bruno, M.J.; Hooft, J.E. van; Besselink, M.G.; Voermans, R.P.; Bollen, T.L.; Verdonk, R.C.; Santvoort, H.C. van; Dutch Panvreatitis Study Grp
• Date: 2023-05-01
• Journal: The American Journal of Gastroenterology
• Volume: 118
• Issue: 5
• Pages: 880 - 891
• DOI: doi:10.14309/ajg.0000000000002157