Management of the disconnected pancreatic duct in pancreatic necrosis

Authors

• C Mel Wilcox, Digestive Health Institute, Orlando Health, Orlando, Florida. Electronic address: charles.wilcox@orlandohealth.com.
• Ji Young Bang, Digestive Health Institute, Orlando Health, Orlando, Florida. Electronic address: jiyoung.bang@orlandohealth.com.
• Akwi Asombang, Harvard, Massachusetts General Hospital, Boston, Massachusetts.
• Chloe Bennett, Yale School of Medicine, New Haven, Connecticut. Electronic address: chloe.bennett@yale.edu.
• Yan Bi, Mayo Clinic, Jacksonville, Florida. Electronic address: bi.yan@mayo.edu.
• Wojciech Blogowski, Rush University Medical Center, Chicago, Illinois; University of Zielona Gora, Poland. Electronic address: Wojciech_Blogowski@rush.edu.
• James Buxbaum, Keck Medicine of USC, Los Angeles, California. Electronic address: james.buxbaum@med.usc.edu.
• Vinay Chandrasekhara, Mayo Clinic, Rochester, Minnesota. Electronic address: Chandrasekhara.Vinay@mayo.edu.
• Wei-Shen Chin, Department of Radiology, Orlando Health, Orlando, Florida. Electronic address: wei-shen.chinmd@orlandohealth.com.
• Darwin Conwell, University of Kentucky College of Medicine, Lexington, Kentucky. Electronic address: darwin.conwell@uky.edu.
• Gregory A. Coté, Oregon Health & Science University, Portland, Oregon. Electronic address: coteg@ohsu.edu.
• Timothy B. Gardner, Dartmouth Geisel School of Medicine, Hanover, New Hampshire. Electronic address: timothy.b.gardner@hitchcock.org.
• Pramod Garg, Department of Gastroenterology at All India Institute of Medical Sciences, New Delhi, India. Electronic address: pgarg10@gmail.com.
• Nalini Guda, Advocate Health - MidwestFollow
• Robert Hawes, Digestive Health Institute, Orlando Health, Orlando, Florida. Electronic address: robert.hawes@orlandohealth.com.
• Yasmin G. Hernandez-Barco, Harvard, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: yhernandez-barco@mgh.harvard.edu.
• Emily Jonica, Oregon Health & Science University, Portland, Oregon. Electronic address: jonica@ohsu.edu.
• Prashant Kedia, Methodist Health, Dallas, Texas. Electronic address: PrashantKedia@mhd.com.
• Thomas Kowalski, Jefferson Health, Philadelphia, Pennsylvania. Electronic address: Thomas.kowalski@jefferson.edu.
• Vivek Kumbhari, Mayo Clinic, Jacksonville, Florida. Electronic address: kumbhari.vivek@mayo.edu.
• Linda Lee, Harvard, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: LLEE@bwh.harvard.edu.
• Jorge Machicado, University of Michigan, Ann Arbor, Michigan. Electronic address: jorge_machicado@icloud.com.
• Samuel H. Mardini, University of Kentucky College of Medicine, Lexington, Kentucky. Electronic address: mardinihe@uky.edu.
• Desiree Morgan, Department of Radiology, University of Alabama, Birmingham, Alabama. Electronic address: dmorgan@uabmc.edu.
• Thiruvengadam Muniraj, Yale School of Medicine, New Haven, Connecticut. Electronic address: thiruvengadam.muniraj@yale.edu.
• Udayakumar Navaneethan, Digestive Health Institute, Orlando Health, Orlando, Florida. Electronic address: Udayakumar.Navaneethan@orlandohealth.com.
• Veeral M. Oza, Prizma Health, Greenville, South Carolina. Electronic address: veeralmoza@gmail.com.
• Parth J. Parekh, Capital Digestive Care, Norfolk, Virginia. Electronic address: parthjparekh@gmail.com.
• Swati Pawa, Wake Forest University School of Medicine, North Carolina. Electronic address: spawa@wakehealth.edu.
• Rajesh Puri, Institute of Digestive & Hepatobiliary Sciences, Medanta, Gurgaon, Haryana, India. Electronic address: Purirajesh1969@gmail.com.
• et al

Recommended Citation

Wilcox CM, Bang JY, Asombang A, Bennett C, Bi Y, Blogowski W, Buxbaum J, Chandrasekhara V, Chin WS, Conwell D, Coté GA, Gardner TB, Garg P, Guda N, Hawes R, Hernandez-Barco YG, Jonica E, Kedia P, Kowalski T, Kumbhari V, Lee L, Machicado J, Mardini SH, Morgan D, Muniraj T, Navaneethan U, Oza VM, Parekh PJ, Pawa S, Puri R, Rastogi A, Reddy DN, Saumoy M, Sawhney M, Vege SS, Talukdar R, Tarnasky P, Tellez-Avila F, Thakkar S, Thiruvengadam N, Vivian E, Waxman I, Willingham FF, Varadarajulu S; U.S. Pancreatic Disease Study Group. Management of the Disconnected Pancreatic Duct in Pancreatic Necrosis. Clin Gastroenterol Hepatol. 2025 Oct;23(11):1878-1887.e3. doi: 10.1016/j.cgh.2025.05.024. Epub 2025 Jul 17. PMID: 40680906.

Abstract

Disconnected pancreatic duct (DPD) and the associated syndrome are increasingly recognized as complications of severe pancreatitis. Despite the increased appreciation for this disorder and its treatment, there remain many questions regarding definition, diagnosis, and management. We utilized the expertise of the US Pancreatic Disease Study Group to address 7 important questions derived from review of the literature pertaining to DPD in the setting of endoscopic treatment for necrotizing pancreatitis. Seven important questions were derived and following review by each member, consensus was reached. The 7 questions followed by recommendations included the appropriate definition for the syndromes, the radiographic definition for diagnosis; the appropriate timing for evaluation for diagnosis; the ideal diagnostic method; the use of pancreatic duct stents in this syndrome; the utility and safety of double plastic stents following endoscopic transmural drainage, and the role of surgical therapy. Important diagnostic and therapeutic questions were derived which should be useful for the management of these patients as well as important research questions going forward.

Type

Article

PubMed ID

40680906