Permanent Indwelling Transmural Stents for Endoscopic Treatment of Patients With Disconnected Pancreatic Duct Syndrome Long-term Results Felix I. Te ´llez-Avin ˜a, MD, MSc, PhD,* Luis E. Casasola-Sa ´nchez, MD,* Miguel A ´ . Ramı´rez-Luna, MD,* A ´ ngela Sau ´l, MD,* Enrique Murcio-Pe ´rez, MD,* Carlos Chan, MD,w Luis Uscanga, MD,w Gilberto Duarte-Medrano, MD,* and Francisco Valdovinos-Andraca, MD* Introduction: Disconnected pancreatic duct syndrome (DPDS) is defined as the complete disruption of the main pancreatic duct, the result are peripancreatic fluid collections or pancreatic leaks. The aim of this study was to report the results of derivative endoscopic treatment of DPDS in a long-term follow-up period. Patients and Methods: We performed a retrospective analysis of prospectively collected data. Endoscopic treatment consisted of transmural drainage with 2 double pigtail plastic stents (7 F and 4 cm) deployed under endoscopic ultrasound guidance. Results: In total, 21 patients were included in our study. There were 15 (71%) men and the median age was 36 years (range, 23 to 86 y). The principal etiology of DPDS was acute pancreatitis. A total of 20 (95.2%) patients were diagnosed with DPDS by endoscopic pancreatography and only 1 (4.8%) patient by magnetic resonance cholangiopancreatography (MRCP). The median follow-up time was 28 months (range, 7 to 76 mo). Technique success was 100% and initial clinical success was 80.9% (17/21). Three (17.6%) of these patients required a new endoscopic procedure with success in all cases. During follow-up, 11 (52%) patients developed diabetes mellitus and 3 patients (14%) developed exocrine pancreatic insufficiency. There were 5 (15%) patients with complications. Conclusion: According to our data, endoscopic treatment with the placement of a permanent indwelling transmural stents is a useful and safe tool for the treatment of DPDS. Key Words: endoscopy, disconnected pancreatic duct syndrome, EUS (J Clin Gastroenterol 2016;00:000–000) D isconnected pancreatic duct syndrome (DPDS) was first described by Kozarek in 1991 and is defined as the complete disruption of the main pancreatic duct (MPD), leaving distal pancreatic tissue without a connection to the digestive tract. The result of this syndrome is peripancreatic fluid collections (PFC) or pancreatic leaks. The real prev- alence is unknown because there have been only a few studies on the real incidence of DPDS. 1–3 Acute necrotizing pancreatitis is the most common etiology of DPDS, and 35% to 50% of patients with walled-off necrosis (WON) will eventually be diagnosed with DPDS. Chronic pan- creatitis, pancreas divisum, and traumatic or idiopathic pancreatitis are other causes of DPDS. 3,4 Endoscopic treatment is not performed to reconnect the viable pancreatic tissue directly to the gastrointestinal (GI) tract, but rather this treatment communicates the GI tract (duodenum or stomach) to the collection, so the dis- connected pancreatic tissue drains fluids to the collection, and through the stent, the collection is emptied into the GI tract. Surgical treatment, including both resection and derivative procedures, has been the traditional treatment of DPDS because percutaneous and medical treatments have low success rates and high morbidity and are thus no longer recommended for DPDS. However, endoscopic manage- ment, with or without endoscopic ultrasound, provides similar success rates as surgery but less morbidity and mortality. Currently, most physicians recommend surgical derivative techniques as first-line treatment of DPDS. 5–10 The aim of this study was to report the results of derivative endoscopic treatment of DPDS in a long-term follow-up period. PATIENTS AND METHODS We performed a retrospective analysis of prospectively collected data. Every patient with DPDS from 2008 to 2015 was included. Paper and electronic charts were reviewed. All patients gave their written informed consent before the procedure and all were evaluated routinely with a contrast- enhanced computed tomographic (CT) scan before the procedure. We recorded demographic information, etiol- ogy, location, size, CT, or magnetic resonance imaging results, endoscopic or other management, complications, clinical course and outcomes (success, failure, number of procedures) and pancreatography to confirm the diagnosis. Inclusion criteria for the study were patients with DPDS who underwent endoscopic treatment of WON, pancreatic pseudocyst (PPC), or pancreatic abscess. Excluded were patients in whom a transpapillary stent was placed, or successful bridging of the pancreatic duct leak was Received for publication July 13, 2016; accepted September 23, 2016. From the *National Institute Medical Sciences and Nutrition Salvador Zubiran; and wPancreas Clinic, National Institute of Medical Sci- ences and Nutrition Salvador Zubira´n, Mexico City, Mexico. The authors declare that they have nothing to disclose. Address correspondence to: Felix I. Te´llez-Avin˜a MD, MSc, PhD, Department of Gastrointestinal Endoscopy, Instituto Nacionalde Ciencias Me´dicas y Nutricio´n, Salvador Zubira´n, Mexico City, Mexico (e-mail: felixtelleza@gmail.com). Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCG.0000000000000754 ORIGINAL ARTICLE J Clin Gastroenterol  Volume 00, Number 00, ’’ 2016 www.jcge.com | 1 Copyright r 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.