Timing and Location are Keys: ERCP Success and Its Benefit in MPD Injury after Acute Pancreatitis

Transpapillary therapy remains a critical treatment modality for main pancreatic duct (MPD) injury after acute necrotizing pancreatitis. This study aimed to verify the factors linked to the technical success of transpapillary drainage by endoscopic retrograde cholangiopancreatography (ERCP) in managing MPD injury, and the impact of technical success on tube duration and overall survival.

A retrospective analysis was conducted on patients who underwent ERCP for MPD injuries following acute pancreatitis from May 2019 to April 2021. Univariate and multivariate logistic regression analyses were employed to identify factors associated with successful treatment. Kaplan-Meier curves were used to analyze the impact of technical success on tube duration and overall survival.

We included 63 patients in whom MPD opacification was achieved (43 technical successes and 20 failures). The technical success group had a significantly higher proportion of patients whose interval from onset of acute pancreatitis to endoscopic transpapillary drainage (IOP) was less than 90 days (58.14%) than the failure group (20.00%, P = 0.005). Multivariate analysis revealed that an IOP < 90 days (OR = 0.24, 95% CI: 0.06-0.91, P = 0.036) and MPD injury located outside the head and neck of the pancreas (OR = 4.66, 95% CI: 1.10-19.77, P = 0.036) were independently associated with technical success. Technical success was associated with a shorter median tube indwelling time (10.3 months, 95% CI: 7.3-13.3) compared to technical failure (16.8 months, 95% CI: 12.3-21.3, P = 0.025).

ERCP should be performed within 90 days in patients with MPD injury, and the procedure has a higher success rate when the injury occurs outside the head and neck of the pancreas. This technical success significantly shortens drainage tube indwelling time and improves patients' quality of life.