Pancreatic duct disruption, disconnection linked to fourfold higher risk for fistula formation
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CHARLOTTE, N.C. — Pancreatic duct disruption and disconnection were associated with increased short- and long-term complications in patients with necrotizing pancreatitis, according to data presented at the ACG Annual Scientific Meeting.
“Acute pancreatitis is complicated by necrosis of the pancreas and peripancreatic tissues in 20% of cases,” Vibhu Chittajallu, MD, a second-year GI fellow at the Digestive Health Institute at University Hospitals Cleveland Medical Center and Case Western Reserve University, told attendees. “Necrosis of the pancreatic parenchyma may lead to loss of integrity of the pancreatic duct resulting in pancreatic duct disruption or disconnection which can be complicated by pancreatic ascites formation.”
To characterize the short- and long-term outcomes associated with pancreatic duct (PD) disruption and disconnection among patients with necrotizing pancreatitis (NP), Chittajallu and colleagues evaluated 613 patients admitted between 2009 and 2019 at a large tertiary academic center. Researchers defined PD disruption as partial interruption of PD and disconnection as complete interruption of PD. Among patients in this cohort, 78% had intact PD, 15% had disrupted PD and 7% had disconnected PD.
According to study results, patients who presented with a recurrent episode of NP had higher occurrences of disrupted (71%) and disconnected (65%) PD compared with patients with intact PD (55%). NP involvement also was associated with an increased occurrence of both disruption (29%) and disconnection (23%).
Further analysis revealed those with PD disconnection and disruption had an increased risk for pancreatic fistula (16%) and distal biliary strictures (26% and 31%, respectively). In addition, disruption and disconnection correlated with a three to six times greater likelihood of pancreatic fistula formation and duodenal ulceration.
Patients with disconnected PD had the highest occurrence of acute kidney injury (31%), altered mental status (35%), readmission (47%) and duodenal ulceration (12%), as well as a nearly threefold increased risk for developing chronic abdominal pain.
“We identified that necrotizing pancreatitis complicated by pancreatic duct disruption is associated with a four times increased risk of pancreatic fistula formation,” Chittajallu noted. “Pancreatic duct disruption and disconnection are more frequently identified by recurrent episodes rather than first episodes of necrotizing pancreatitis.”
He added, “Our study is the first to distinguish differences between pancreatic duct disruption and disconnection, noting increases in occurrence of acute kidney injury, altered mental status, readmission and duodenal ulceration. Pancreatic duct disruption incurred a near threefold risk of chronic abdominal pain development.”
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Chittajallu V, et al. Abstract S6: Short- and long-term outcomes of pancreatic duct disruption and disconnection in necrotizing pancreatitis. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meting).
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