DPDS Demystified: Imaging Insights and Minimally Invasive Management

Abstract

Abstract Aim This article retrospectively evaluates the radiological imaging features in establishing the diagnosis of pancreatic duct disconnection along with outlining the effective management protocols. Materials and Methods Sixty-three patients with radiological or clinical suspicion of pancreatic duct disconnection were identified. Their computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) images, clinical data, and laboratory parameters from medical records were retrieved and analyzed. Endoscopic retrograde cholangiopancreatography (ERCP) findings or raised amylase values in the necrotic collection higher than three times the reference range were considered as proven cases of disconnected pancreatic duct syndrome (DPDS) for the study. Multiple parameters were assessed on imaging to establish the diagnosis of DPDS. SPSS software was used for statistical analysis and radiological imaging features of pancreatic duct disconnection were evaluated. Laboratory parameters of serum amylase/lipase and amylase/lipase values from the collection were also studied along with the mode of clinical management and outcome on follow-up. Results The radiological imaging features of pancreatic duct disconnection were assessed in 63 patients in which it was seen that magnetic resonance imaging had a significantly higher accuracy rate in diagnosing DPDS as opposed to CT. Minimally invasive procedures such as endoscopic cystogastrostomy was the preferred management in most cases with ERCP stenting being the next favored management of choice. Resolution or reduction of symptoms was mostly seen on follow-up with 12.69% of patients developing complications. Conclusion This study highlighted the imaging features of DPDS apart from ascertaining the parameters that could be assessed to aid in early diagnosis of DPDS. MRCP has a higher accuracy rate compared with CT in diagnosing DPDS. A combination of two or more parameters on MRCP was more accurate in the identification of DPDS rather than a single parameter. Minimally invasive treatment options such as endoscopic transluminal drainage with or without stenting are currently preferred in the treatment of DPDS over surgical management. Early diagnosis and prompt management of DPDS is essential to reduce the onset of serious complications apart from improving the quality of life of these patients posttreatment.