Original article Endotherapy is effective for pancreatic ductal disruption: A dual center experience Rohit Das a , Georgios I. Papachristou a, * , Adam Slivka a , Jeffrey J. Easler c , Jennifer Chennat a , Jessica Malin b , Justin B. Herman b , Sobia N. Laique b , Umar Hayat b , Yinn Shaung Ooi b , Mordechai Rabinovitz a , Dhiraj Yadav a , Ali A. Siddiqui b a Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA b Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA c Division of Gastroenterology and Hepatology, Indiana University, USA article info Article history: Available online xxx Keywords: Endoscopic retrograde cholangiopancreatography Pancreatic ducts Pancreatic fistula Pancreatic pseudocyst Pancreatitis Pancreatic duct stent abstract Background and study aims: Pancreatic duct (PD) disruptions occur as a result of different etiologies and can be managed medically, endoscopically, or surgically. The aim of this study was to provide an eval- uation on the efficacy of endotherapy for treatment of PD disruption in a large cohort of patients and identify factors that predict successful treatment outcome. Patients and methods: We retrospectively evaluated consecutive patients who underwent endoscopic retrograde pancreatography (ERP) for transpapillary pancreatic stent placement for PD disruption from 2008 to 2013 at two tertiary referral institutions. PD disruption was defined as extravasation of contrast from the pancreatic duct as seen on ERP. Therapeutic success was defined by resolution of PD leak on ERP, clinical, and/or imaging evaluation. Results: We evaluated 107 patients (58% male, mean age 53 years) with PD disruption. Etiologies of PD disruption were acute pancreatitis (36%), post-operative (31%), chronic pancreatitis (29%), and trauma (4%). PD disruption was successfully bridged by a stent in 45 (44%) patients. Two patients developed post-sphincterotomy bleeding, two had stent migration, and two patients died as a result of post-ERP related complications. Placement of a PD stent was successful in 103/107 (96%) patients. Therapeutic success was achieved in 80/107 (75%) patients. Non-acute pancreatitis etiologies and absence of com- plete duct disruption were independent predictors of therapeutic success. Conclusions: Endoscopic therapy using a transpapillary stent for PD disruption is safe and effective. Absence of complete duct disruption and non-AP etiologies determine a favorable endoscopic outcome. Copyright © 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved. Introduction Pancreatic duct (PD) disruption can occur as a consequence of several different types of injuries to the pancreatic duct, including acute pancreatitis (AP), chronic pancreatitis (CP), abdominal trauma, and pancreatic surgery. PD disruptions are generally clas- sified as either being internal when the PD communicates with the peritoneal/pleural cavity or external when the PD communicates with the skin. Clinically, they may resolve spontaneously, or present with clinical features of an ongoing pancreatic leak, most commonly as a pancreatic fluid collection (PFC). Diagnostically, endoscopic retrograde pancreatography (ERP) has the highest ac- curacy to identify injury to the PD [1e3]. Patients with PD disruptions require prolonged hospital stay and an overall increased health care utilization as compared to patients who sustain pancreatic injury without ductal disruption [4,5]. They are initially managed with supportive care by a combi- nation of different measures [6e9]. Supportive management has been associated with a 50e60% success rate for resolution of PD disruption; for patients who remain refractory, surgery was tradi- tionally the only option. Although surgical management of PD * Corresponding author. UPMC Presbyterian, 200 Lothrop Street, Mezzanine Level, C-2 Wing, Pittsburgh, PA 15213, USA. Tel.: þ1 412 647 8132; fax: þ1 412 647 1880. E-mail address: papachri@pitt.edu (G.I. Papachristou). Contents lists available at ScienceDirect Pancreatology journal homepage: www.elsevier.com/locate/pan http://dx.doi.org/10.1016/j.pan.2015.12.176 1424-3903/Copyright © 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved. Pancreatology xxx (2016) 1e6 Please cite this article in press as: Das R, et al., Endotherapy is effective for pancreatic ductal disruption: A dual center experience, Pancreatology (2016), http://dx.doi.org/10.1016/j.pan.2015.12.176