This would assist healing of the ductal disruption and thus improve the outcome after transmural drainage. It should also lower the risk of PfC recurrence after removal of the transmural stent. However, data on the role PCI 32765 of combining transpapillary stenting with transmural drainage are limited and inconsistent. Hookey et al.7 performed endoscopic drainage of PFC in 116 patients and reported no significant difference in the success rates between patients who underwent transmural drainage alone versus those who had combined transmural and transpapillary drainage. There was a trend towards higher recurrence rates in patients with combined transpapillary and transmural

stent placement versus those who underwent transmural stenting alone (P = 0.015).The authors speculate that transmural drainage may allow the cyst-enterostomy fistula to remain patent for a longer time, even in the event of stent blockage, and the addition of transpapillary drainage may hinder this process. The transpapillary stent was placed either bridging the disruption in the pancreatic duct or within the PFC itself. However, a subgroup analysis was not done to evaluate

the effect of a bridging stent and to see whether a stent bridging the pancreatic disruption had a better outcome, as had been shown by other studies.8,9 In this issue of Journal of Gastroenterology and Hepatology, Tevino et al. report a retrospective analysis evaluating the effect of transpapillary pancreatic duct stenting on treatment KU-60019 clinical trial outcome of transmural drainage in 110 patients with PFCs.10 Patients first underwent endoscopic retrograde cholangiopancreatography (ERCP) and if a duct disruption was present, this was bridged. Transpapillary stents were not placed when the disruption could not be bridged.

Transmural drainage Erythromycin was performed in the same session; two 7 or 10 Fr stents were inserted. In patients with abscess or necrosis, a 10 Fr nasocystic catheter was placed in addition to the stents to facilitate periodic flushing. Forty (36%) of the 110 patients had successful bridging of the pancreatic duct disruption by stent. On univariate analysis, treatment success was significantly higher in those patients who, in addition to transmural drainage, underwent MPD stenting compared to those who did not undergo stenting (97.5% versus 80%; crude risk ratio = 1.22; 95% CI: 1.06–1.26; P = 0.01). In a multivariable analysis, this positive association remained significant (RR adjusted = 1.14; 95% CI: 1.01–1.29; P = 0.036), even after adjusting for etiology of pancreatitis, type and location of PFC, luminal compression at endoscopy, enteral nutrition, white blood cell count, and number of endoscopic interventions. However, recurrence of PFC was not significantly different between patients who did or did not undergo transpapillary pancreatic stenting along with the transmural drainage.