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Disconnected Pancreatic Duct Syndrome: Pancreatitis of the Disconnected Pancreas and Its Role in the Development of Diabetes Mellitus
Thiruvengadam, Nikhil R. Forde, Kimberly A. Miranda, Janille Kim, Christopher Behr, Spencer Masharani, Umesh Arain, Mustafa A.
Thiruvengadam, Nikhil R.
Forde, Kimberly A.
Miranda, Janille
Kim, Christopher
Behr, Spencer
Masharani, Umesh
Arain, Mustafa A.
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Journal article
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2022-02-19
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Medicine
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http://dx.doi.org/10.14309/ctg.0000000000000457
Abstract
INTRODUCTION: Disconnected pancreatic duct syndrome (DPDS) is a recognized complication of necrotizing pancreatitis (NP). Manifestations include recurrent peripancreatic fluid collections (R-PFC) and pancreatocutaneous fistulae (PC-Fistulae). Pancreatitis of the disconnected pancreatic segment (DPDS-P) and its relationship to new-onset diabetes after pancreatitis (NODAP) are not well characterized. METHODS: We performed a retrospective cohort study of consecutive patients with NP admitted to University of California, San Francisco from January 2011 to June 2019. A diagnosis of a disconnected pancreatic duct (PD) was confirmed using computed tomography and magnetic resonance cholangiopancreatography/endoscopic retrograde cholangiopancreatography. DPDS was defined as a disconnected PD presenting with R-PFC, PC-Fistulae, or DPDS-P. The primary outcome was NODAP, defined as diabetes mellitus (DM) occurring >3 months after NP. Cox proportional hazards regression was used to evaluate the relationship between DPDS and NODAP. RESULTS: Of 171 patients with NP in this study, the mean clinical follow-up was 46 ± 18 months and the imaging follow-up was 38 ± 20 months. Twenty-seven patients (16%) developed DPDS-P at a median of 28 months. New-onset DM occurred in 54 of the 148 patients (36%), with 22% developing DM within 3 months of NP and 14% developing NODAP at a median of 31 months after AP. DPDS-P was associated with NODAP when compared with non-DPDS patients (adjusted hazard ratio 5.63 95% confidence interval: 1.69–18.74, P = 0.005) while R-PFCs and PC-Fistulae were not. DISCUSSION: DPDS and NODAP occurred in 28% and 14% of the patients, respectively. Pancreatitis of the disconnected pancreas occurred in 16% of the patients and was associated with higher rates of NODAP when compared with patients with other manifestations of DPDS and patients without DPDS.
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Thiruvengadam, Nikhil R. MD1,2,3,4; Forde, Kimberly A. MD, PhD5; Miranda, Janille BS4; Kim, Christopher MD6; Behr, Spencer MD6; Masharani, Umesh MBBS7; Arain, Mustafa A. MD4,8. Disconnected Pancreatic Duct Syndrome: Pancreatitis of the Disconnected Pancreas and Its Role in the Development of Diabetes Mellitus. Clinical and Translational Gastroenterology 13(2):p e00457, February 2022. | DOI: 10.14309/ctg.0000000000000457
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Lippincott, Williams & Wilkins
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Clinical and Translational Gastroenterology, Vol. 13
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