BACKGROUND AND AIMS: Several studies have shown improved short-term outcome with endoscopic transmural drainage and necrosectomy for the treatment of walled-off pancreatic necrosis. However, knowledge on the long-term prognosis after such treatment is limited. The aim of present study was to evaluate long-term outcomes in patients endoscopically treated with transmural drainage and necrosectomy. METHODS: We retrospectively follow up 125 patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy in 2010-2017. All patients received plastic pigtail stents and nasocystic catheter. Additional external drainage was performed in 41 patients. Main outcomes were survival, pancreatic function, development of co-morbidities, ability to work and social status. RESULTS: During a median follow-up of 4.3 years, nine (7%) patients died. Seven deaths were unrelated to pancreatic disease, and two patients died of pancreatic cancer. Twenty-two (18%) patients developed exocrine pancreatic insufficiency. Thirty-six (32%) previous non-diabetics developed endocrine insufficiency. Endoscopic necrosectomy during admission (odds ratio (OR) = 1.28, 95% confidence interval (CI) 1.05-1.56; p = 0.015) and therapy on the main pancreatic duct (OR = 8.08, 95% CI 2.43-26.9; p < 0.001) during follow-up predicted development of exocrine insufficiency. Severity on computed tomography predicted endocrine insufficiency (OR = 1.61, 95% CI 1.24-2.09; p < 0.001). Most patients regained their working capacity and preserved their marital status. CONCLUSIONS: This study provides robust data on the long-term outcome of patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy. The favourable outcomes on survival, pancreatic function and social status support current recommendations of endoscopic transmural drainage and necrosectomy being the treatment of choice for walled-off pancreatic necrosis.
BACKGROUND AND AIMS: Several studies have shown improved short-term outcome with endoscopic transmural drainage and necrosectomy for the treatment of walled-off pancreatic necrosis. However, knowledge on the long-term prognosis after such treatment is limited. The aim of present study was to evaluate long-term outcomes in patients endoscopically treated with transmural drainage and necrosectomy. METHODS: We retrospectively follow up 125 patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy in 2010-2017. All patients received plastic pigtail stents and nasocystic catheter. Additional external drainage was performed in 41 patients. Main outcomes were survival, pancreatic function, development of co-morbidities, ability to work and social status. RESULTS: During a median follow-up of 4.3 years, nine (7%) patients died. Seven deaths were unrelated to pancreatic disease, and two patients died of pancreatic cancer. Twenty-two (18%) patients developed exocrine pancreatic insufficiency. Thirty-six (32%) previous non-diabetics developed endocrine insufficiency. Endoscopic necrosectomy during admission (odds ratio (OR) = 1.28, 95% confidence interval (CI) 1.05-1.56; p = 0.015) and therapy on the main pancreatic duct (OR = 8.08, 95% CI 2.43-26.9; p < 0.001) during follow-up predicted development of exocrine insufficiency. Severity on computed tomography predicted endocrine insufficiency (OR = 1.61, 95% CI 1.24-2.09; p < 0.001). Most patients regained their working capacity and preserved their marital status. CONCLUSIONS: This study provides robust data on the long-term outcome of patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy. The favourable outcomes on survival, pancreatic function and social status support current recommendations of endoscopic transmural drainage and necrosectomy being the treatment of choice for walled-off pancreatic necrosis.
Authors: Robbert A Hollemans; Olaf J Bakker; Marja A Boermeester; Thomas L Bollen; Koop Bosscha; Marco J Bruno; Erik Buskens; Cornelis H Dejong; Peter van Duijvendijk; Casper H van Eijck; Paul Fockens; Harry van Goor; Wilhelmina M van Grevenstein; Erwin van der Harst; Joos Heisterkamp; Eric J Hesselink; Sijbrand Hofker; Alexander P Houdijk; Tom Karsten; Philip M Kruyt; Cornelis J van Laarhoven; Johan S Laméris; Maarten S van Leeuwen; Eric R Manusama; I Quintus Molenaar; Vincent B Nieuwenhuijs; Bert van Ramshorst; Daphne Roos; Camiel Rosman; Alexander F Schaapherder; George P van der Schelling; Robin Timmer; Robert C Verdonk; Ralph J de Wit; Hein G Gooszen; Marc G Besselink; Hjalmar C van Santvoort Journal: Gastroenterology Date: 2018-11-02 Impact factor: 22.682
Authors: Zachary L Smith; Martin H Gregory; Jeffrey Elsner; Bader A Alajlan; Divya Kodali; Thomas Hollander; Gregory S Sayuk; Gabriel D Lang; Koushik K Das; Daniel K Mullady; Dayna S Early; Vladimir M Kushnir Journal: Dig Endosc Date: 2018-09-30 Impact factor: 7.559
Authors: Koenraad J Mortele; Walter Wiesner; Lisa Intriere; Shridhar Shankar; Kelly H Zou; Babek N Kalantari; Alex Perez; Eric vanSonnenberg; Pablo R Ros; Peter A Banks; Stuart G Silverman Journal: AJR Am J Roentgenol Date: 2004-11 Impact factor: 3.959
Authors: Hjalmar C van Santvoort; Marc G Besselink; Olaf J Bakker; H Sijbrand Hofker; Marja A Boermeester; Cornelis H Dejong; Harry van Goor; Alexander F Schaapherder; Casper H van Eijck; Thomas L Bollen; Bert van Ramshorst; Vincent B Nieuwenhuijs; Robin Timmer; Johan S Laméris; Philip M Kruyt; Eric R Manusama; Erwin van der Harst; George P van der Schelling; Tom Karsten; Eric J Hesselink; Cornelis J van Laarhoven; Camiel Rosman; Koop Bosscha; Ralph J de Wit; Alexander P Houdijk; Maarten S van Leeuwen; Erik Buskens; Hein G Gooszen Journal: N Engl J Med Date: 2010-04-22 Impact factor: 91.245
Authors: Peter A Banks; Thomas L Bollen; Christos Dervenis; Hein G Gooszen; Colin D Johnson; Michael G Sarr; Gregory G Tsiotos; Santhi Swaroop Vege Journal: Gut Date: 2012-10-25 Impact factor: 23.059
Authors: Sandra van Brunschot; Janneke van Grinsven; Hjalmar C van Santvoort; Olaf J Bakker; Marc G Besselink; Marja A Boermeester; Thomas L Bollen; Koop Bosscha; Stefan A Bouwense; Marco J Bruno; Vincent C Cappendijk; Esther C Consten; Cornelis H Dejong; Casper H van Eijck; Willemien G Erkelens; Harry van Goor; Wilhelmina M U van Grevenstein; Jan-Willem Haveman; Sijbrand H Hofker; Jeroen M Jansen; Johan S Laméris; Krijn P van Lienden; Maarten A Meijssen; Chris J Mulder; Vincent B Nieuwenhuijs; Jan-Werner Poley; Rutger Quispel; Rogier J de Ridder; Tessa E Römkens; Joris J Scheepers; Nicolien J Schepers; Matthijs P Schwartz; Tom Seerden; B W Marcel Spanier; Jan Willem A Straathof; Marin Strijker; Robin Timmer; Niels G Venneman; Frank P Vleggaar; Rogier P Voermans; Ben J Witteman; Hein G Gooszen; Marcel G Dijkgraaf; Paul Fockens Journal: Lancet Date: 2017-11-03 Impact factor: 79.321