Clinical outcomes following endoscopic or video‐assisted retroperitoneal management of acute pancreatitis with large (>15 cm) walled‐off pancreatic necrosis: Retrospective, single tertiary center cohort study

Abstract

Objective Acute pancreatitis with walled‐off necrosis (WON) is associated with considerable morbidity and mortality. Previous studies have evaluated outcomes in WON collections of limited size, while data about large WON with long‐term follow‐up are lacking. We aimed to report our experience in managing large WON. Methods Between 2010 and 2020, consecutive patients with large (>15 cm) WON were identified from a prospectively maintained database. Patients with chronic pancreatitis or an index intervention 90 days or more from the debut of symptoms were excluded. We registered clinical and technical outcomes following minimally invasive treatment in WON >15 cm. Follow‐up was a minimum of 1 year. Results Overall, 144 patients with WON >15 cm, with a median age of 60 (interquartile range [IQR] 49–69) years, were included. The median WON size was 19.2 cm (IQR 16.8–22.1). Most patients were treated with endoscopic transluminal drainage (93%). The median length of stay was 53 days (IQR 39–76) and 61 (42%) patients needed intensive care support during their hospital stay. As 143 patients (99%) were managed using endoscopic or video‐assisted retroperitoneal techniques, only one (0.7%) patient needed an open necrosectomy. Procedure‐related adverse events occurred in 10 (7%) patients. Overall, 24 patients (17%) died during admission, all due to multiorgan failure. The median follow‐up was 35 months (IQR 15–63.5). Complete resolution was achieved in all remaining patients. Conclusion Minimally invasive treatment of large WON is feasible, with a minimal need for surgery and acceptable rates of morbidity and mortality.

EUS-guided drainage of large walled-off pancreatic necroses using plastic versus lumen-apposing metal stents: a single-centre randomised controlled trial

“…Our treatment algorithm included a scheduled weekly dilatation of the drainage tract for patients in the DPT group, which may not be the standard practice. However, it is our experience that in patients with large WON, endoscopic dilatation is required to counteract spontaneous closure of the tract and to avoid retention in WON with the subsequent risk of systemic infection 3 23. Obviously, this resulted in there being more endoscopic procedures carried out in the DPT group than in the LAMS group.…”

“…In general, mortality among patients with infected WON is estimated to be 10%–20%. Our group recently presented retrospective data from patients with WON exceeding 15 cm in diameter and found an in-hospital mortality of 17% 23. These data come from consecutive patients referred for treatment at our tertiary care unit between 2010 and 2020.…”

Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis

“…A recent study found no difference between 10, 15 and 20 mm LAMS for PFC [ 47 ]. Another study also indicated that endoscopic drainage of WON patients is effective and less invasive than surgery [ 48 ].…”

Transrectal and transcolonic endoscopic ultrasound-guided drainage and necrosectomy in walled-off pancreatic necrosis: a retrospective, single-center case series

“…Methods Nine patients with infected WON not amenable for EUS guided transgastric drainage or VARD were retrospectively enrolled 1 2 3 .…”