Combined endoscopic and percutaneous drainage of organized pancreatic necrosis

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

“…[15] On the basis of a meta-analysis of 8 researches considering 286 patients the percutaneous drainage of infected pancreatic necrosis was efficient in 44% of them. [16] Percutaneous drainage can be exploited together with endoscopic drainage as a method of a multiple approach to the necrotic cavity, [9,14,17] particularly when it comes to penetration of necrosis down the abdominal cavity, up to the minor pelvis. [18] It was proved that the use of percutaneous drainage during endoscopic treatment of WOPN decreases the amount of endoscopic and radiological procedures as well as hospitalization time.…”

“…[18] It was proved that the use of percutaneous drainage during endoscopic treatment of WOPN decreases the amount of endoscopic and radiological procedures as well as hospitalization time. [17,19] In addition, it increases the efficiency of interventional treatment of WOPN. [17,19] In the described case endoscopic drainage being the only way of access to the necrotic collection was insufficient.…”

“…[17,19] In addition, it increases the efficiency of interventional treatment of WOPN. [17,19] In the described case endoscopic drainage being the only way of access to the necrotic collection was insufficient. On the 27th day of endoscopic drainage it became necessary to guide the percutaneous drain under radiological imaging.…”

Treatment of pancreatic necrosis – the Multimodal Glasgow Algorithm

“…Lee and his colleagues routinely undertook stepwise dilation to 20FG along with twice weekly lavage (22), with resolution in 83% but two prospective studies have suggested a more realistic primary success rate of PCD of 33% to 35% (20,40). Early PCD placement before 3 weeks is associated with a prolonged course and more frequent drain exchanges (30,31), underscoring the importance of maturation of walled off necrosis before intervention. Persistent external fistulas occur in up to one third of patients.…”

“…Where there is evidence of infection or systemic sepsis it is our practice to use a naso-cystic catheter, which can be used for continuous lavage of the cavity. Factors associated with a failure of resolution are large size and retro-colic extension of the collections and in these cases, other approaches or combinations of approaches should be considered (31,37). Other options include the multiple gateway technique (41), where two or three transmural stents are placed under EUS guidance, one of which is used for nasocystic cavity lavage and the others to facilitate drainage of necrotic debris.…”