Indwelling double-pigtail plastic stents for treating disconnected pancreatic duct syndrome-associated peri-pancreatic fluid collections: long-term safety and efficacy

Background and study aims: Long-term transmural double-pigtail stent (DPS) placement is recommended for patients with disconnected pancreatic duct syndrome (DPDS) and peripancreatic fluid collections (PFC). Long-term safety and efficacy of indwelling DPS were evaluated. Patients and methods: Medical files of patients treated with DPS for DPDS-associated PFC and a follow-up ≥48 months were reviewed. Early (<30 days) and late complications of DPS placement were evaluated and the primary endpoint –the incidence rate of late complications per 100 patients-years– was calculated. Short- and long term success rate of endoscopic treatment and PFC recurrence rate were among secondary endpoints. Results: From 2002 to 2014 we identified 116 patients [follow-up: 80.6 (34.4) months]. Among early complications (n=20), 6 occurred peri-interventionally. Late complications (n=17) were mainly pain due to DPS-induced ulcer or erosion (n=10) and 14 of these were treated conservatively or by stent removal. Two gastro-pancreatico-colo-cutaneous fistulas and one persisting bleed required surgical intervention. No DPS-related deaths were recorded. The incidence rate of late complications was 2.18 per 100 patient-years of follow-up; 95%CI [1.27, 3.49]. Short- and long-term success rate of endoscopic treatment was 97.4% [94.5, 100) and 94% [89.6, 98.3], respectively. The PFC recurrence rate was 28% [20.1, 35.9] and 92.3% of them occurred within the first two years. Stent migration, chronic pancreatitis and length of stent size (>6cm) were independently associated with higher rates of PFC recurrence. Conclusions: Long-term transmural drainage with DPS is a safe and effective treatment for DPDS-associated PFCs. However, about one fourth of PFC will recur.