Review article: Translumenal endoscopic debridement of organized pancreatic necrosis--the first step towards natural orifice translumenal endoscopic surgery.

BACKGROUND: Over the last decades, gastrointestinal endoscopy has transformed from serving purely diagnostic purposes to therapeutic applications. One recent major progress is taking the endoscope beyond the gastrointestinal lumen into the peritoneal cavity for diagnostic and therapeutic procedures. The first step towards Natural Orifice Translumenal Endoscopic Surgery (NOTES) was translumenal endoscopic debridement of pancreatic necrosis. AIM: To overview current status of endoscopic debridement of organized pancreatic necrosis. Finally, we take a short look into the potential future of translumenal endoscopic procedures.
METHODS: Medical databases were searched for relevant publications, dealing with endoscopic debridement of pancreatic necrosis and NOTES.
RESULTS: All current published studies concerning endoscopic debridement of organized pancreatic necrosis were retrospectively performed and relatively small (largest n = 25). Success rates varies from 80-93% and complication rates from 7-20%. There was no procedure related mortality reported. Published NOTES experiments showed feasibility of a variety of transgastric, transcolonic and transvaginal procedures in the porcine model.
CONCLUSION: Endoscopic debridement seems to be an effective and relatively safe minimally invasive therapy in patients with symptomatic organized pancreatic necrosis and is the first step towards NOTES. Further comparative studies need to define its definitive role in the management of these patients.