EUS-Guided Endoscopic Transgastric Necrosectomy in Patients with Infected Necrosis in Acute Pancreatitis |
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| Affiliation: | 1. Departments of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands;2. Departments of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands;3. Departments of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands;1. Weill Cornell Medical College, New York, New York, USA;2. Jefferson Medical College, Philadelphia, Pennsylvania, USA;1. Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA;2. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA;3. Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA;1. Department of Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, Lyon, France;2. Faculty of Medicine, UCBL1, Lyon, France;3. Department of Hepatogastroenterology, Edouard Herriot Hospital, HCL, Lyon, France;4. Department of Radiology, Edouard Herriot Hospital, HCL, Lyon, France;1. Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York;3. Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland;6. Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois;71. Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York;10. Gastroenterology and Hepatology, Stanford Hospital and Clinics, Palo Alto, California;5. Gastroenterology and Hepatology, Ochsner Health System, New Orleans, Louisiana;7. Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland;106. Gastroenterology and Hepatology, Jefferson University, Philadelphia, Pennsylvania;12. Gastroenterology and Hepatology, Mount Sinai Medical Center, New York, New York;123. Gastroenterology and Hepatology, Montefiore, New York, New York;9. Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;8. Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas;84. Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri;4. Department of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida |
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| Abstract: | Background: Infected pancreatic and peripancreatic necrosis in acute pancreatitis is potentially lethal, with mortality rates up to 35%. Therefore, there is growing interest in minimally invasive treatment options, such as (EUS-guided) endoscopic transgastric necrosectomy. Methods: Retrospective cohort study on EUS-guided endoscopie transgastric necrosectomy in patients with infected necrosis in acute pancreatitis. Results: 8 patients (age 38–75, mean 50 years) with documented infected peripancreatic or pancreatic necrosis were included. Median time to first intervention was 33 days (range 17–62) after onset of symptoms. At the time of first intervention 2 patients had organ failure. All patients were managed on the patient ward. Initial endoscopie drainage was successful in all patients, a median of 4 (range 2–6) subsequent endoscopie necrosectomies were needed to remove all necrotic tissue. Two patients needed additional surgical intervention because of pneumoperitoneum (n = 1) and insufficient endoscopie drainage (n = 1). Six patients recovered, with 1 mild relapse during follow-up (median 12, range 8–60 months). One patient died. Conclusion: EUS-guided endoscopie transgastric necrosectomy of infected necrosis in acute pancreatitis appears to be a feasible and relatively safe treatment option in patients who are not critically ill. Further randomized comparison with the current ‘gold standard’ is warranted to determine the place of this treatment modality. |
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