Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis

Charnley, Richard; Lochan, Rajiv; Gray, H; O'Sullivan, Chris; Scott, J; Oppong, KW

doi:10.1055/s-2006-944731

Cited by 167 publications

(128 citation statements)

References 10 publications

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“…In such cases with the application of drainage early operation can be avoided [1, 4,6,8,10,11,12,21,26,32,35,39,42]. Others suggest transluminal endoscopic (NOTES) procedure if percuteanous drainage is failed [7,13,15,27,30,31,41] Some authors suggest the combination of external and internal drainage with endoscpopic necrosectomy [27,30,]. Complications related to percutaneous drainage are rare.…”

Section: How To Drain?mentioning

confidence: 99%

“…In this chapter the authors suggest reviewing the transmural endoscopic (NOTES) necrosectomy as a minimal invasive method. More and more authors in selected patients use this method for necrosectomy with a successful rate of 73-92% [2,7,13,15,27,30,31,41]. The necrotic cavity can be drained to the stomach or the duodenum.…”

Section: How To Drain?mentioning

confidence: 99%

“…The necrotic cavity can be drained to the stomach or the duodenum. The effectiveness of this method can be enhanced with the use of endoscopic ultrasound (ES) [7,13,15,27,30,31,41].…”

Section: How To Drain?mentioning

confidence: 99%

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The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

Szentkereszty¹,

Kotán²,

Sápy³

2012

Acute Pancreatitis

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What to drain? Acute peripancreatic fluid collection (APFC)According to the Atlanta Classification peripancreatic fluid collection develops in the early phase of acute pancreatitis in about 40% of cases. The acute fluid collection usually develops around the pancreas but sometimes emerges in the glandular area and does not contain a high quantity of necrosis. Not rarely, it spreads into the chest, mediastinum and/or into the pararenal area. Several fluid collections can develop at the same time and can shuttle together. The rich pancreatic enzyme content of the fluid can indicate communication with the pancreatic duct or indicate parenchymal necrosis. They do not have definite walls, and are limited by the walls of the surrounding organs. In a significant number of cases (about 30-50%), spontaneous resolution occurs without surgical or other intervention. If they do not show tendency towards resolution, they can become of significant size and cause clinical symptoms or complications [5,6,33,44]. The most frequent complaints caused by a big, 8-15 cm size acute fluid collection are pain, tension, and increasing abdominal pressure which can significantly worsen the efficiency of breathing [1,9]. In other cases they can cause compression symptoms (jaundice, duodenal obstruction) or bleeding can develop inside of them. Another frequent complication is the

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Section: How To Drain?mentioning

confidence: 99%

Section: How To Drain?mentioning

confidence: 99%

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The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

Szentkereszty¹,

Kotán²,

Sápy³

2012

Acute Pancreatitis

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“…However, operation-related morbidity and mortality, and longer hospitalization are not uncommon complications [1,2] . Transgastric endoscopic necrosectomy has been recently introduced as the effective and alternative management for infected pancreatic necrosis and pancreatic abscess [3][4][5][6][7] . However, up to 40% of patients who undergo endoscopic necrosectomy may need an additional percutaneous approach for subsequent peripancreatic fluid collection or non-resolution of pancreatic necrosis [8] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic fibrin glue injection for closure of pancreatocutaneous fistula following transgastric endoscopic necrosectomy

Jang¹,

Park²,

Moon³

et al. 2008

WJG

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Transgastric endoscopic necrosectomy has been recently introduced as the effective and alternative management of infected pancreatic necrosis and pancreatic abscess. However, up to 40% of patients who undergo endoscopic necrosectomy may need an additional percutaneous approach for subsequent peripancreatic fluid collection or non-resolution of pancreatic necrosis. This percutaneous approach may lead to persistent pancreatocutaneous fistula, which remains a serious problem and usually requires prolonged hospitalization, or even open-abdominal surgery. We describe the first case of pancreatocutaneous fistula and concomitant abdominal wall defect following transgastric endoscopic necrosectomy and percutaneous drainage, which were endoscopically closed with fibrin glue injection via the necrotic cavity.

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“…Similar success rates were reported subsequently in other small retrospective studies. [45][46][47] Subsequently, two large multicentre trials from Germany and USA confirmed a clinical success rate of over 80% and an acceptable rate of complication of 14% to 20% for endoscopic necrosectomy. 48,49 Biliary FC-SEMS provide a larger diameter fistulous tract for drainage of WOPN but will not permit the advancement of an endoscope into the collection.…”

mentioning

confidence: 99%

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Madácsy

Kaltsidis²

2017

Int J Gastrointest Interv

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A B S T R A C TEndoscopic ultrasound (EUS)-guided management of abdominal fluid collections adjacent to the gastroduodenal lumen is a relatively new concept attracting a lot of interest in recent years. The ability of EUS to identify and drain these collections in the same session accounts for the surge of interest in these novel techniques. On the other hand, the complexity of these interventions and associated serious complications has moderated the enthusiasm of novice endoscopists to some extent and reiterated that focused research and technical innovations are needed to make EUS-guided drainage simpler and safer. Self-expandable metallic stents (SEMS) have emerged in the last decade in the endoscopic management of malignant luminal gastrointestinal strictures. The use of SEMS in the management of benign conditions (biliary, pancreatic, and colonic strictures) is also rapidly expanding. Recently, fully-covered (FC)-SEMS have been successfully used for drainage of peripancreatic and pericholecystic fluid collections. Here we will review the existing data and future directions in the use of FC-SEMS for such drainage procedures. We will also review the literature on novel "purpose-made" prostheses, such as the lumen-apposing metallic stents, which aim to address technical problems arising in EUS-guided drainage procedures when conventional SEMS are used. Further development of these and other similar devices may transform EUS-guided drainage procedures from an esoteric concept to "mainstream", first-line intervention.

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Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis

Abstract: Endoscopic necrosectomy is a safe method for treatment of infected pancreatic necrosis. Multiple procedures are usually needed. It may be combined with other methods of surgical intervention. Larger prospective studies will more precisely define its role.

Cited by 167 publications

References 10 publications

The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

Endoscopic fibrin glue injection for closure of pancreatocutaneous fistula following transgastric endoscopic necrosectomy

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

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