Impact of disconnected pancreatic duct on recurrence of fluid collections and new-onset diabetes: do we finally have an answer?

Disconnected pancreatic duct (DPD) is a frequent occurrence in cases with walled-off necrosis (WON). The impact of DPD on recurrence of collection after removal of metal stents is not clear. Also, association between DPD and new-onset diabetes mellitus (DM) is not well known. In a large cohort of patients with WON, we observed DPD in majority (3/4th) of the cases. The presence of DPD was a significant risk factor for the recurrence of fluid collections as well as new-onset DM. However, the incidence of recurrent fluid collections and the requirement of reintervention was low (<10%). ### Background DPD is defined as complete disruption of PD with isolation of viable portion of upstream pancreas.1 DPD may be associated with recurrent pancreatic fluid collections (PFC) and predispose these patients to new-onset DM.2–7 In addition, the strategies to prevent recurrences of PFCs are unclear. The limitations of existing literature include small sample size, short follow-up periods and lack of objective evaluation. In this study, we aimed to evaluate the impact of DPD on the recurrence of PFC and the development of new-onset DM in subjects who underwent drainage of WON using large calibre metal stents (LCMS). ### Methods The data of subjects with WON who underwent endoscopic ultrasound (EUS)-guided drainage using LCMS between January 2013 and June 2017 were analysed from a prospectively maintained database. EUS-guided drainage was performed using LCMS (Nagi; Taewoong Medical, Gyeonggido, South Korea) as per the standard technique.8 Approximately 4–8 weeks after drainage, imaging (MRI with MR cholangiopancreatography (MRCP)) was performed to establish the resolution of WON and delineate PD (figure 1). Endoscopic retrograde cholangiopancreatography (ERCP) was performed in all the cases to confirm the findings on MRCP and place a PD stent in cases with leak or stricture (figure 2). LCMSs were removed regardless of the presence or absence …