27 - Short and Long-Term Outcomes of Pancreatic Duct Disruption and Disconnection in Necrotizing Pancreatitis

Vibhu Chittajallu, MD¹, Yazan Abu Omar, MD², Ariel B. Sims, MD³, Christian Cuvillier Padilla, MD⁴, David Long, DO², Roberto Simons-Linares, MD², Prabhleen Chahal, MD^4
1University Hospitals Cleveland Medical Center/ Case Western Reserve University, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³University of Chicago, Chicago, IL; ⁴Cleveland Clinic, Cleveland, OH

Introduction: Pancreatic duct (PD) disruption and disconnection are less common but important complication of necrotizing pancreatitis (NP). We investigated the short and long-term outcomes of patients with NP complicated by PD disruption and disconnection.

Methods: All index admissions of patients with NP managed between 2009-2019 at our large tertiary academic center were identified. PD disruption was defined as partial interruption of PD; PD disconnection was defined as complete interruption of PD. Diagnosis of PD disruption or disconnection was made by CT, MRI, or EUS during index admission without a previously known diagnosis. Patients with NP and PD disruption or disconnection were compared to control patients with NP and intact PD. Logistic regression models were constructed.

Results: A total of 613 patients were included: 476 patients (78%) with intact PD, 94 patients (15%) had disrupted PD, and 43 patients (7%) had disconnected PD (Table 1). Patients presenting with a recurrent episode of NP had higher occurrences of disrupted [67 (71%)] and disconnected PD [28 (65%)] than patients with intact PD [263 (55%)] (p=0.01). NP involvement of the pancreatic body was associated with increased occurrence of both PD disruption [27 (29%)] and disconnection [10 (23%)] compared to intact PD [83 (17%)] (p=0.03).

Both disrupted and disconnected PD patients had increased development of pancreatic fistulas [15 (16%) and 7 (16%), p< 0.01] and distal biliary strictures [29 (31%) and 11 (26%), p< 0.01] compared to intact PD patients. Pancreatic fistula formation was 4x more likely in disrupted and disconnected PD patients than in intact PD patients (p< 0.01). Additionally, disrupted and disconnected PD patients developed duodenal ulcers 3-6x more frequently than intact PD patients (p=0.02, 0.04) (Table 2).

Patients with disconnected PD had the highest occurrence of acute kidney injury (AKI) [11 (31%), p< 0.01], altered mental status (AMS) [15 (35%), p=0.04], readmission [20 (47%), p< 0.01], and duodenal ulceration [5 (12%), p=0.03] compared to both intact and disrupted PD patients. Disconnected PD patients had a nearly three-fold increased risk of developing chronic abdominal pain compared to intact and disrupted PD patients (OR 2.91, p< 0.01).

Discussion: Our study characterized the increased short and long-term complications associated with PD disruption and disconnection in NP. Additionally, this study is one of the first to distinguish differences in clinical outcomes between PD disruption and disconnection.




Disclosures:


Vibhu Chittajallu, MD¹, Yazan Abu Omar, MD², Ariel B. Sims, MD³, Christian Cuvillier Padilla, MD⁴, David Long, DO², Roberto Simons-Linares, MD², Prabhleen Chahal, MD⁴, 27, Short and Long-Term Outcomes of Pancreatic Duct Disruption and Disconnection in Necrotizing Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.