The role of endoscopic treatment of pancreatic duct disruption
in patients with walled-oﬀ pancreatic necrosis
· Marian Smoczyński
· Krystian Adrych
Received: 13 March 2018 / Accepted: 29 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background The place of endoscopic techniques in the treatment of main pancreatic duct (MPD) disruption arising in the
course of acute necrotizing pancreatitis (ANP) remains unclear. The aim of this study was to describe the ﬁndings of endo-
scopic retrograde pancreatography (ERP) in patients with walled-oﬀ necrosis (WON). It was attempted to evaluate the role
of endoscopic treatment of pancreatic duct disruption in patients with WON.
Methods The retrospective analysis of results and complications with particular emphasis to all ERP procedures in the group
of 226 patients was conducted, which underwent endoscopic treatment of symptomatic WON between years 2001 and 2016
in the Department of Gastroenterology and Hepatology of Medical University of Gdańsk.
Results ERP was performed in 204/226 (90.27%) patients. Partial and complete disruption of the MPD were identiﬁed in
103 (50.49%) and 63 (30.89%) out of 204 patients, respectively. Endoscopic treatment was used in all 166 patients with MPD
disruption. The success of endoscopic treatment of MPD disruption was achieved in 138/161 (85.71%) patients with WON.
The therapeutic success of WON endotherapy was achieved in 214/226 (94.69%) patients. The mean follow-up duration was
56 (SD = 37.06) [range 14–158] months. Long-term success of treatment of WON was achieved in 182/226 (80.53%) patients.
Conclusions MPD disruption occurs in the majority of patients with WON. Partial disruption of the MPD is more frequent
than complete disruption of the duct. This study conducted on a large group of patients demonstrated that prosthesis inser-
tion into the MPD in patients with disruption of the MPD in the course of ANP is one of the key elements in endoscopic
treatment of WON. Passive transpapillary drainage is an eﬀective method of treating MPD disruptions, which improves
long-term outcomes of endoscopic treatment in patients with WON.
Keywords Endoscopic drainage · Endoscopic retrograde pancreatography · Pancreatic duct disruption · Walled-oﬀ
pancreatic necrosis · Acute pancreatitis
Acute necrotizing pancreatitis (ANP) may lead to disrup-
tion of the main pancreatic duct (MPD) , which mani-
fests as a contrast leak into the necrotic collection during
endoscopic retrograde pancreatography (ERP) . Proximal
part of MPD and distal part of MPD is used to be referred
to major duodenal papilla [3, 4]. Thereby, the duct in pan-
creatic tail and the part of the duct in the pancreatic body
(closer to the tail of the pancreas) are described as the distal
part of MPD, while the duct in pancreatic head and the part
of the duct in the pancreatic body (closer to the head of the
pancreas) are deﬁned as the proximal part of MPD [3, 4].
Partial disruption of the pancreatic duct is diagnosed when
the pancreatic duct ﬁlls with contrast distally to the disrup-
tion site . Complete disruption equals contrast extravasa-
tion outside the duct without contrast ﬁlling the distal part
of the MPD .
Endoscopic treatment of MPD disruption includes endo-
scopic sphincterotomy (ES) and implantation of a prosthesis
into the MPD to ensure physiological drainage of pancreatic
juice into the duodenum [2–4]. Endotherapy is a widely used
method of treatment of pancreatic necrosis [5–7]. The place
of endoscopic techniques in the treatment of MPD disruption
arising in the course of ANP remains unclear.
We have used endoscopic treatment in patients with
walled-oﬀ necrosis (WON) at our center since 2001 [5, 6, 8].
Ever since the introduction of this method, we perform ERP
and Other Interventional Techniques
* Mateusz Jagielski
Department of Gastroenterology and Hepatology,
Medical University of Gdansk, Smoluchowskiego 17,
80-214 Gdansk, Poland