Management of the Disconnected Pancreatic Duct in Pancreatic Necrosis

Disconnected pancreatic duct (DPD) and the associated syndrome are increasingly recognized as complications of severe pancreatitis. Despite the increased appreciation for this disorder and its treatment, there remain many questions regarding definition, diagnosis, and management. We utilized the expertise of the U.S. Pancreatic Disease Study Group to address 7 important questions derived from review of the literature pertaining to DPD in the setting of endoscopic treatment for necrotizing pancreatitis. Seven important questions were derived and following review by each member, consensus was reached. The 7 questions, followed by recommendations, included the appropriate definition for the syndromes and the radiographic definition for diagnosis; the appropriate timing for evaluation for diagnosis; the ideal diagnostic method; the use of pancreatic duct stents in this syndrome; the utility and safety of double plastic stents following endoscopic transmural drainage; and the role of surgical therapy. Important diagnostic and therapeutic questions were derived, which should be useful for the management of these patients as well as important research questions going forward.