Dual Modality Drainage for Symptomatic Walled-Off Pancreatic Necrosis Reduces Length of Hospitalization, Radiological Procedures, and Number of Endoscopies Compared to Standard Percutaneous Drainage

Glück, Michael; Ross, Andrew; Irani, Shayan; Lin, Otto S.; Gan, S. Ian; Fotoohi, Mehran; Hauptmann, Ellen; Crane, Robert; Siegal, Justin; Robinson, David; Traverso, L. William; Kozarek, Richard A.

doi:10.1007/s11605-011-1759-4

Cited by 131 publications

(90 citation statements)

References 39 publications

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

Jagielski

Smoczyński

Studniarek

et al. 2016

CRIM

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Pancreatic necrosis and the necrosis of surrounding tissues are found to be local complications occurring in 15% of patients suffering from acute pancreatitis. Walled-off pancreatic necrosis (WOPN) is in fact pancreatic fluid collection surrounded by a well-defined wall and inclusive of liquefied necrosis and elements (debris) of necrotic tissues. Endotherapy is an efficient method of treatment for patients with symptomatic WOPN. Often single transmural access to the necrotic collection is sufficient. However, in some patients with infected WOPN, the application of an extra way of access to pancreatic necrosis is a must. In these particular patients the optimal strategy is joining a few minimally invasive methods, which allows multiplexing of access to the collection. Herein we described the case of treatment with the use of minimally invasive techniques in a patient suffering from an infected WOPN, in which the single transmural access to the necrotic collection appeared to be insufficient and the application of an extra way of access to pancreatic necrosis was necessary. Only joining together both minimally invasive techniques-transmural drainage and percutaneous drainage had become efficient enough and led to complete healing of the patient.

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Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

Jagielski

Smoczyński

Studniarek

et al. 2016

CRIM

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“…Compared to surgical necrosectomy, an endoscopic approach significantly reduces proinflammatory response and improves clinical outcome in ANP patients [52]. However, when used as a single modality approach, it requires more sessions of necrosectomy for definitive treatment than in combination with other interventional procedures [53, 61-63]. A large meta-analysis found that endoscopic necrosectomy has success rate of 81% as a single treatment modality with a complication rate of 36% [64].…”

Section: Management Of Acute Necrotic Collections and Walled-off Necrmentioning

confidence: 99%

Management of (Peri)Pancreatic Collections in Acute Pancreatitis

et al. 2019

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The development of (peri)pancreatic fluid collections are frequent local complications in acute pancreatitis. These collections are classified as early (acute peripancreatic fluid collection or acute necrotic collection) or late (walled-off necrosis or pseudocyst). The majority of pancreatic fluid collections resolve spontaneously and do not require intervention. However, infection may require intervention. Interventions may include endoscopic or percutaneous catheter drainage, or in a next step endoscopic or surgical necrosectomy, minimally invasive or open. The best timing for the first intervention is still under investigation. Whereas some use antibiotics to postpone intervention until the stage of walled-off necrosis, others drain earlier. Endoscopic drainage of (peri)pancreatic fluid collections is now the preferred approach of drainage due to reduced morbidity as compared to surgical or percutaneous drainage. However, each collection must be treated according to a tailored approach. The final treatment should take into consideration anatomic characteristics, patient preference, comorbidity profile of the patient, and physician discretion. This review summarizes the current evidence on the treatment of (peri)pancreatic fluid collections.

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“…However, when feasible, DMD may reduce length of hospitalization, radiological procedures and number of endoscopies in these patients. 49 A recent paper had attempted a dual drainage in early pancreatitis by using a trans-papillary (instead of transmural) approach as the second head of drainage in addition to percutaneous drainage. This approach is, therefore, feasible in pancreatic fluid collections which have not yet developed a wall.…”

Section: Modified Step-up Approachmentioning

confidence: 99%

Percutaneous Interventions in Acute Necrotizing Pancreatitis

Sharma¹

2016

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Acute pancreatitis (AP) is a disease of varying severity with acute necrotizing pancreatitis (ANP) being the severe form of AP. ANP needs multidisciplinary management and is associated with significant mortality and morbidity. Local complications of ANP viz. acute necrotic collections (ANC) and walled off pancreatic necrosis (WOPN) need intervention if they are associated with symptoms, sepsis or worsening organ failure. As surgery is associated with higher morbidity and mortality, there is paradigm shift in the management of these local complications with an increased emphasis on conservative and minimally invasive treatment approach. Image-guided percutaneous drainage (PCD) is a minimally invasive intervention that helps in drainage of infected collections, temporizes sepsis and improves outcomes in these patients. The present review discusses the utility of various percutaneous interventions in management of variety of pancreatic collections occurring in ANP. The available evidence, technical details and complications and emerging innovations in the field are also summarized. Acute Pancreatitis (AP) is an acute inflammatory disease of the pancreas, which is characterized by the frequent development of local or systemic complications. It is broadly divided into two morphological patterns: interstitial, which is merely associated with edema of the pancreatic parenchyma or necrotizing, in which peri-pancreatic and/or pancreatic necrosis is present. [1][2][3] In the early phase of acute pancreatitis the heightened inflammatory response dominates the clinical picture while the late phase is characterized by development of local infective as well as non-infective complications. The pancreatic inflammation results in exudation of pancreatic juice and subsequent injury to the peri-pancreatic fat and tissues. 2,3 This results in formation of collections which may be associated with both interstitial and necrotizing pancreatitis. While the collections formed in relation to interstitial pancreatitis are predominantly fluid and are called as acute fluid collections (AFC), KEYWORDS:

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Dual Modality Drainage for Symptomatic Walled-Off Pancreatic Necrosis Reduces Length of Hospitalization, Radiological Procedures, and Number of Endoscopies Compared to Standard Percutaneous Drainage

Abstract: DMD for symptomatic WOPN reduces LOH, radiological procedures, and number of ERCPs compared to SPD.

Cited by 131 publications

References 39 publications

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

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

Management of (Peri)Pancreatic Collections in Acute Pancreatitis

Percutaneous Interventions in Acute Necrotizing Pancreatitis

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