BACKGROUND: Direct endoscopic necrosectomy (DEN) for treatment of walled-off pancreatic necrosis (WOPN) has been performed as an alternative to operative or percutaneous therapy. OBJECTIVE: To report the largest combined experience of DEN performed for WOPN. DESIGN: Retrospective chart review. SETTING: Six U.S. tertiary medical centers. PATIENTS: A total of 104 patients with a history of acute pancreatitis and symptomatic WOPN since 2003. INTERVENTIONS: DEN for WOPN. MAIN OUTCOME MEASUREMENTS: Resolution or near-resolution of WOPN without the need for surgical or percutaneous intervention and procedural complications. RESULTS: Successful resolution was achieved in 95 of 104 patients (91%). Of the patients in whom it failed, 5 died during follow-up before resolution, 2 underwent operative drainage for persistent WOPN, 1 required surgery for massive bleeding on fistula tract dilation, and 1 died periprocedurally. The mean time to resolution from the initial DEN was 4.1 months. The first débridement was performed a mean of 63 days after the initial onset of acute pancreatitis. In 73%, the entry was transgastric with median tract dilation diameter of 18 mm. The median number of procedures was 3 with 2 débridements. Complications occurred in approximately 14% and included 5 retrogastric perforations/pneumoperitoneum, which were managed nonoperatively. Univariate analysis identified a body mass index >32 as a risk factor for failed DEN. LIMITATIONS: Retrospective, highly specialized centers. CONCLUSIONS: This large, multicenter series demonstrates that transmural, minimally invasive endoscopic débridement of WOPN performed in the United States is an efficacious and reproducible technique with an acceptable safety profile.
BACKGROUND: Direct endoscopic necrosectomy (DEN) for treatment of walled-off pancreatic necrosis (WOPN) has been performed as an alternative to operative or percutaneous therapy. OBJECTIVE: To report the largest combined experience of DEN performed for WOPN. DESIGN: Retrospective chart review. SETTING: Six U.S. tertiary medical centers. PATIENTS: A total of 104 patients with a history of acute pancreatitis and symptomatic WOPN since 2003. INTERVENTIONS:DEN for WOPN. MAIN OUTCOME MEASUREMENTS: Resolution or near-resolution of WOPN without the need for surgical or percutaneous intervention and procedural complications. RESULTS: Successful resolution was achieved in 95 of 104 patients (91%). Of the patients in whom it failed, 5 died during follow-up before resolution, 2 underwent operative drainage for persistent WOPN, 1 required surgery for massive bleeding on fistula tract dilation, and 1 died periprocedurally. The mean time to resolution from the initial DEN was 4.1 months. The first débridement was performed a mean of 63 days after the initial onset of acute pancreatitis. In 73%, the entry was transgastric with median tract dilation diameter of 18 mm. The median number of procedures was 3 with 2 débridements. Complications occurred in approximately 14% and included 5 retrogastric perforations/pneumoperitoneum, which were managed nonoperatively. Univariate analysis identified a body mass index >32 as a risk factor for failed DEN. LIMITATIONS: Retrospective, highly specialized centers. CONCLUSIONS: This large, multicenter series demonstrates that transmural, minimally invasive endoscopic débridement of WOPN performed in the United States is an efficacious and reproducible technique with an acceptable safety profile.
Authors: Ali A Siddiqui; Jeffrey Easler; Anna Strongin; Adam Slivka; Thomas E Kowalski; Venkata Muddana; Jennifer Chennat; Todd H Baron; David E Loren; Georgios I Papachristou Journal: Dig Dis Sci Date: 2013-11-27 Impact factor: 3.199
Authors: István Hritz; Roland Fejes; András Székely; Iván Székely; László Horváth; Agnes Sárkány; Aron Altorjay; László Madácsy Journal: World J Gastroenterol Date: 2013-06-21 Impact factor: 5.742
Authors: Mohamed Abdelhafez; Mayada Elnegouly; M S Hasab Allah; Mostafa Elshazli; Hany M S Mikhail; Ayman Yosry Journal: Surg Endosc Date: 2013-04-13 Impact factor: 4.584
Authors: Christopher C Thompson; Nitin Kumar; James Slattery; Thomas E Clancy; Michele B Ryan; Marvin Ryou; Richard S Swanson; Peter A Banks; Darwin L Conwell Journal: Pancreatology Date: 2015-12-22 Impact factor: 3.996