Timing and location are keys: ERCP success and its benefit in MPD injury post-acute pancreatitis

Background Trans-papillary therapy remains a critical treatment modality for main pancreatic duct (MPD) injury subsequent to acute necrotizing pancreatitis. This study aimed to verify the factors linked to the technical success of transpapillary drainage by Endoscopic retrograde cholangiopancreatography (ERCP) in managing the MPD injury, and the impact of technical success on the tube duration and overall survival. Methods A retrospective analysis was conducted on patients who underwent ERCP procedures for MPD injuries following acute pancreatitis from May 2019 to April 2021. Univariate and multivariate logistic regression analyses were employed to identify factors associated with successful treatment. Kaplan-Meier curves were used to analyze the impact of technical success on the tube duration and overall survival rate of patients. Results We included 63 patients in whom the MPD opacification was achieved (43 technical succeed and 20 failed). The successful groups exhibited a higher percentage of interval from onset of acute pancreatitis to the endoscopic trans-papillary drainage procedure (IOP) less than 90 days (58.14%) compared to the failed group (20.00%) ( P  = 0.005). This study indicated a statistically significant association between the success rate of endoscopic trans-papillary drainage procedure with IOP less than 90 days (95% CI: 0.06–0.91, P  = 0.036) and MPD injury occurred in areas other than the head and neck of the pancreas (95% CI: 1.10-19.77, P  = 0.036). Technical successful group (median TD time: 10.3 months, 95% CI: 7.3–13.3) shorten the tube indwelling time compared with technical failed group (median TD time: 16.8 months, 95% CI: 12.3–21.3) ( P  = 0.025). Conclusions ERCP should be performed within 90 days in patients with MPD injury, and has a higher success rate with injury occurred in areas other than the head and neck of the pancreas. The technical success could shorten indwelling time of the drainage tube and improve patients' life quality.