Disconnected Pancreatic Duct Syndrome: A Narrative Review of Pathophysiology, Classification, Emerging Diagnosis and Treatment Approaches

Disconnected Pancreatic Duct Syndrome (DPDS) is a complicated outcome of pancreatic injury which is characterised by persistent secretory leakage from an isolated upstream pancreatic segment. Clinically, DPDS is associated with recurrent or non resolving Peripancreatic Fluid Collections (PFC), external pancreatic fistulae, chronic abdominal pain and metabolic derangements, which in most cases result in exocrine and endocrine dysfunction. Different radiological, endoscopic and anatomical-based classification systems have been designed to guide clinical decision-making. Diagnosis also has been progressing to a large extent due to the increasing utility of secretin-enhanced Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), 3D-MRCP, peroral pancreatoscopy and Endoscopic Ultrasound (EUS)-assisted interventions, which enhance the detection of complete ductal disconnections. Management is based on the anatomy of the duct, endoscopic transmural drainage is preferable in cases of partial disruptions, and complete ductal disconnection often requires surgery, such as distal pancreatectomy or pancreaticojejunostomy. The current advances, which include Lumen-Apposing Metal Stents (LAMS), EUS-guided Pancreatic Duct Interventions (EUS-PDI), hybrid endoscopic-percutaneous techniques, and bioengineered anastomotic methods, are changing therapeutic practices to minimally invasive organ-preserving solutions. Early identification and multidisciplinary treatment should also be utilised to decrease morbidity and avoid recurrence of DPDS. Further research on the functional imaging and ductal reconstructive technologies holds promise to advance the long-term outcomes in DPDS. The article critically reviews clinical manifestation of the DPDS, its evolution of classification, diagnostic advancements, and modern management strategies in order to maximise patient outcome.