Copyright ©The Author(s) 2020.
World J Gastroenterol. Dec 7, 2020; 26(45): 7104-7117
Published online Dec 7, 2020. doi: 10.3748/wjg.v26.i45.7104
Table 1 Classifications of pancreatography findings
Ref.Study objectStudy objectiveDescriptorsClassificationPractical implication
Dhir et al[23], 2018EUS-drained WONPancreatography patters in WON and collection recurrence-Duct disconnection; -Leaks-Type I: Disconnection in the neck/body region, with a ductal leak at the proximal end; -Type II: Disconnected duct with a WON distal to the disconnection. It is not possible to ascertain the ductal communication of WON; -Type III: ductal leak without disconnection; -Type IV: Shows a noncommunicating WON, with no disconnectionRecurrence is higher in patters w/ disconnection (types I and II): -Type I: 5/35 patients (14.3%)–62.5% of recurrences; -Type II: 2/18 patients (11.1%) - 25% of recurrences; -Type III: 0/26 patients (0%) - 0% of recurrences; -Type IV: 1/8 patients (12.5%)–12.5% of recurrences
Mutignani et al[35], 2017All pancreatic fistulasGuide endoscopic approach-Leakages; -Disruption (partial); -Disconnection (total)-Type I: Leakages from small side brunches. IH: head | IB: body | IT: tail; -Type II: Leak in the MPD Open (IIO) or Close (IIC); -Type III: leaks after pancreatectomy; IIIP: Proximal pancreas (after distal pancreatectomy); IIID: Distal pancreas (after pancreaticoduodenectomy)-IH and IB: Bridging OR NPD; -IT: Bridging OR cianoacrilate/fibrin/glue/polymer injection at pancreatic tail; -IIO: Bridging OR NPD OR transpapillary stent; -IIC: EUS transmural drain of collection from excluded gland OR EUS pancreaticogastrostomy OR Conversion to IIO and treat as IIO; -IIIP: Transpapillary stent; -IIID: Few endoscopic options. EUS transmural drainage OR nasojejunal drain at the level of dehiscence in continuous aspiration
Nealon et al[37], 2009Pseudocyst due to pancreatitis1Guide the best approach: endoscopic, interventional radiology or surgical intervention-Normal2; -Stricture; -Chronic pancreatitis; -Occlusion; -Communication / no communication with collection-Type I for normal ducts, IA: No communication, IB: With communication; -type II for duct strictures; IIA: no communication; IIB: with communication; -Type III for duct occlusion or disconnected duct syndrome; IIIA: no communication; IIIB: with communication; - Type IV for changes of chronic pancreatitis; IVA: no communication, IVB: with communication-Type I: Endoscopic or percutaneous management; unlikely to require operation; -Type II: Endoscopic management depending on the magnitude and length of the stricture - transpapillary stents for selected ducts; -Type III and type IV: Surgical intervention exclusively
Nealon et al[41], 2002Pseudocyst1 that underwent pancreatography by ERCPGuide the best approach between percutaneous drainage or surgical intervention-Normal2; -Strictures; -Complete cutoff; -Chronic pancreatitis;-MPD-pseudocyst communication or not-Type I: normal duct/no communication with cyst; -Type II: normal duct with duct–cyst communication; -Type III: otherwise normal duct with stricture and no duct–cyst communication; -Type IV: otherwise normal duct with stricture and duct–cyst communication; -Type V: otherwise normal duct with complete cut-off; -Type VI: chronic pancreatitis, no duct–cyst communication; -Type VII: chronic pancreatitis with duct–cyst communication-Type I: consider percutaneous drainage (PD); -Type II: avoid PD; -Type III: consider PD treatment; -Type IV: surgery (avoid PD); -Type V: surgery (avoid PD); -Type VI: surgery (avoid PD); -Type VII: surgery (avoid PD)
Nordback et al[7], 1988Pseudocyst1 that underwent pancreatography by ERCPGuide the best approach-Stenosis; -Pseudocyst opens to the duct; -Pseudocyst is filled-Type I: MPD is imaged up to the end without much stenosis, Pseudocyst may (Type IA) or may not (IB) be filled, but is further away from the main pancreatic duct; -Type II: no main duct stenosis and pseudocyst opens to the duct; -Type III: stenosis of the main pancreatic duct, + filling of the pseudocyst behind the stenosis (IIIA), or not (IIIB)Type I: PD is a good option; Type II: expectant management for 12 wk, if persistent: Internal drainage (PD, endoscopically, surgery); Type III: Internal drainage (external drainage contraindicated); caudal resection
Table 2 Lera-Proença new proposed classification for endoscopic pancreatography findings
TypesFindingEndoscopic approaches
Type INormal MPDNo additional therapy
Type IIStrictureConsider pancreatic stent
Type IIIPartial disruption (MPD contrasts beyond disruption point)Pancreatic stent bridging the rupture
Type IVComplete disruption (MPD does not contrast beyond disruption point), A: With contrast extravasation; B: Without contrast extravasation and abrupt cut-offCT or MRI to confirm or rule out DPDS; Consider long-term transmural indwelling plastic stents
Table 3 Comparation between pancreatography classifications
Ref.Study modalityGuide endoscopic approach?Category for partial MPD disruption?Diagnosis or suspicion of DPDS?
Proença, 2020ERCPYesYesYes
Dhir et al[23], 2018ERCP + MRCPNoYesYes
Mutignani et al[35], 2017Not specifiedYesNoNo
Nealon et al[37], 2009ERCPNoNoNo
Nordback et al[7], 1988ERCPNoNoNo