Efficacy and safety of indwelling double-pigtail stents after endoscopic necrosectomy in patients with necrotizing pancreatitis complicated with disconnected pancreatic duct syndrome: A follow-up study.

Abstract

Background and objectives: Disconnected pancreatic duct syndrome (DPDS) is a significant cause of pancreatic fluid collection (PFC) recurrence in patients with necrotizing pancreatitis (NP). Effective management strategies for DPDS are crucial to improve patient outcomes. This study aimed to evaluate the efficacy and safety of indwelling double-pigtail stents (DPSs) after endoscopic necrosectomy (EN) in patients with NP complicated with DPDS, focusing on the impact on PFC recurrence rates and readmission.

Methods: We conducted a 1-year follow-up of patients with NP complicated with DPDS who underwent drainage or/and EN from June 2015 to November 2022. Patients were divided into 2 groups according to whether with DPS after removal of the metal stent. Additionally, a subgroup analysis was performed to evaluate the impact of stent type (7Fr and 10Fr DPS) after EN. The primary outcome was to assess the 1-year PFC recurrence rate.

Results: Seventy-eight patients with DPDS were included in the study. Recurrence was seen in 7/30 (23.3%) patients with DPS replacement and 34/48 (70.83%) without DPS replacement within 1 year of discharge; the difference was statistically significant. Additionally, the readmission rate significantly decreased in the group with DPS (10.00% vs. 31.25%, P = 0.03). Subgroup analysis indicated that 7Fr DPSs were associated with lower PFC recurrence and adverse event rates compared to 10Fr DPSs.

Conclusion: In patients with NP complicated with DPDS, the replacement and long-term indwelling of DPS can reduce the recurrence rate and hospital readmission rate. Furthermore, the 7Fr DPS size may offer better outcomes in terms of recurrence and safety.