Controversies in EUS-guided treatment of walled-off necrosis

Hocke, Michael; Burmeister, S.; Braden, Barbara; Jenssen, Christian; Arcidiacono, Paolo Giorgio; Iglesias‐García, Julio; Ignee, A.; Larghi, Alberto; Möller, Kathleen; Rimbaș, Mihai; Sun, Siyu; Vanella, Giuseppe; Dietrich, Christoph F.

doi:10.4103/eus-d-21-00189

Endoscopic Ultrasound

2022

DOI: 10.4103/eus-d-21-00189

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Controversies in EUS-guided treatment of walled-off necrosis

Michael Hocke¹,

S. Burmeister²,

Barbara Braden³

et al.

Abstract: This review gives an overview of different techniques in the treatment of post-acute complications of acute pancreatitis. The endoscopic treatment of those complications is currently standard of care. EUS opened up the broad implementation of internal drainage methods to make them safe and effective. Due to different endoscopic approaches worldwide, controversies have arisen that are pointed out in this paper. The main focus was placed on weighing up evidence to find the optimal approach. However, if no eviden… Show more

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Cited by 4 publications

References 99 publications

(108 reference statements)

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Pancreatic ultrasound: An update of measurements, reference values, and variations of the pancreas

Meier,

Lucius,

Möller

et al. 2024

Ultrasound Int Open

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Reliable and reproducible measurement methods have been established, and reference values are used in almost all scientific disciplines. Knowledge of reference values is crucial to distinguish physiological from pathological processes and, therefore, subsequently, for the clinical management of patients. Image storage and documentation of measurements and normal findings should be part of quality assurance in imaging. This paper aims to review the published literature and provide current knowledge of sonographic measurements and reference values of the pancreas. Moreover, the role of clinical influencing factors such as age, gender, constitution, and ethnicity is also analyzed.

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Pancreatic ultrasound: An update of measurements, reference values, and variations of the pancreas

Meier,

Lucius,

Möller

et al. 2024

Ultrasound Int Open

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Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials

Tang,

Ali,

Khizar

et al. 2023

Annals of Medicine

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Background/Aims Acute pancreatitis is a common condition of the digestive system, but sometimes it develops into severe cases. In about 10–20% of patients, necrosis of the pancreas or its periphery occurs. Although most have aseptic necrosis, 30% of cases will develop infectious necrotizing pancreatitis. Infected necrotizing pancreatitis (INP) requires a critical treatment approach. Minimally invasive surgical approach (MIS) and endoscopy are the management methods. This meta-analysis compares the outcomes of MIS and endoscopic treatments. Methods We searched a medical database until December 2022 to compare the results of endoscopic and MIS procedures for INP. We selected eligible randomized controlled trials (RCTs) that reported treatment complications for the meta-analysis. Results Five RCTs comparing a total of 284 patients were included in the meta-analysis. Among them, 139 patients underwent MIS, while 145 underwent endoscopic procedures. The results showed significant differences ( p < 0.05) in the risk ratios (RRs) for major complications (RR: 0.69, 95% confidence interval (CI): 0.49–0.97), new onset of organ failure (RR: 0.29, 95% CI: 0.11–0.82), surgical site infection (RR: 0.26, 95% CI: 0.07–0.92), fistula or perforation (RR: 0.27, 95% CI: 0.12–0.64), and pancreatic fistula (RR: 0.14, 95% CI: 0.05–0.45). The hospital stay was significantly shorter for the endoscopic group compared to the MIS group, with a mean difference of 6.74 days (95% CI: −12.94 to −0.54). There were no significant differences ( p > 0.05) in the RR for death, bleeding, incisional hernia, percutaneous drainage, pancreatic endocrine deficiency, pancreatic exocrine deficiency, or the need for enzyme use. Conclusions Endoscopic management of INP performs better compared to surgical treatment due to its lower complication rate and higher patient life quality.

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Managing complications of chronic pancreatitis: a guide for the gastroenterologist

Capurso,

Tacelli,

Vanella

et al. 2023

Expert Review of Gastroenterology & Hepatology

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Controversies in EUS-guided treatment of walled-off necrosis

Cited by 4 publications

References 99 publications

Pancreatic ultrasound: An update of measurements, reference values, and variations of the pancreas

Pancreatic ultrasound: An update of measurements, reference values, and variations of the pancreas

Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials

Managing complications of chronic pancreatitis: a guide for the gastroenterologist

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