Endoscopic necrosectomy of walled-off pancreatic necrosis by large-bore percutaneus metal stent: a new opportunity?

Tringali, Andrea; Prampero, Salvatore Francesco Vadalà di; Bove, Vincenzo; Perri, Vincenzo; Greca, Antonio La; Pepe, Gilda; Cozza, Valerio; Costamagna, Guido

doi:10.1055/s-0043-125313

Cited by 15 publications

(21 citation statements)

References 15 publications

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“…Unfortunately, there is limited data about PEN through SEMS and its clinical outcomes, even if the available evidences are encouraging. In our experience, SEMS-assisted PEN was technically feasible, leading to the resolution of symptoms and stent removal in 20 days, in line with those previously reported [ 5 , 7 , 8 , 22 , 25 ]. Moreover, we did not experience any periprocedural or delayed adverse event, though we do not have to disregard the possible risks of a combined approach (i.e., bleeding, suprainfection, stent migration and stent occlusion due to the LAMS [ 30 ], abdominal pain).…”

Section: Discussionsupporting

confidence: 90%

“…Patients included in this series were discharged after a mean of 61 days after percutaneous SEMS removal, although the length of the hospital stay varied among patients and were strongly influenced by the several complications occurred (i.e., stomach and colon perforation after ETDN attempt, aspiration pneumonia, critical illness neuropathy etc.). In the case series by Tringali and colleagues [ 7 ], the median length of hospitalization after esophageal stent placement was 18 days, similar with those reported by Navarrete and Cerecedo-Rodriguez and colleagues (15 and 21 days, respectively) [ 5 , 21 ].…”

Section: From Sinus Tract Endoscopy To Sems-assisted Percutaneous Necrosectomy For the Treatment Of Wopn: A Literature Overviewsupporting

confidence: 78%

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EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

et al. 2021

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Background Endoscopic ultrasound-guided drainage is suggested as the first approach in the management of symptomatic and complex walled-off pancreatic necrosis. Dual approach with percutaneous drainage could be the best choice when the necrosis is deep extended till the pelvic paracolic gutter; however, the available catheter could not be large enough to drain solid necrosis neither to perform necrosectomy, entailing a higher need for surgery. Therefore, percutaneous endoscopic necrosectomy through a large bore percutaneous self-expandable metal stent has been proposed. Case presentation In this study, we present the case of a 61-year-old man admitted to our hospital with a history of sepsis and persistent multiorgan failure secondary to walled-off pancreatic necrosis due to acute necrotizing pancreatitis. Firstly, the patient underwent transgastric endoscopic ultrasound-guided drainage using a lumen-apposing metal stent and three sessions of direct endoscopic necrosectomy. Because of recurrence of multiorgan failure and the presence of the necrosis deeper to the pelvic paracolic gutter at computed tomography scan, we decided to perform percutaneous endoscopic necrosectomy using an esophageal self-expandable metal stent. After four sessions of necrosectomy, the collection was resolved without complications. Therefore, we perform a revision of the literature, in order to provide the state-of-art on this technique. The available data are, to date, derived by case reports and case series, which showed high rates both of technical and clinical success. However, a not negligible rate of adverse events has been reported, mainly represented by fistulas and abdominal pain. Conclusion Dual approach, using lumen apposing metal stent and percutaneous self-expandable metal stent, is a compelling option of treatment for patients affected by symptomatic, complex walled-off pancreatic necrosis, allowing to directly remove large amounts of necrosis avoiding surgery. Percutaneous endoscopic necrosectomy seems a promising technique that could be part of the step-up-approach, before emergency surgery. However, to date, it should be reserved in referral centers, where a multidisciplinary team is disposable.

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Section: Discussionsupporting

confidence: 90%

Section: From Sinus Tract Endoscopy To Sems-assisted Percutaneous Necrosectomy For the Treatment Of Wopn: A Literature Overviewsupporting

confidence: 78%

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

et al. 2021

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“…Thorsen et al [13] reported 5 cases with a technical success of 100%, while the clinical success was 80% after an average of 5.75 necrosectomy sessions. Tringali et al [14] reported 3 cases of WOPN resolution by percutaneous necrosectomy through SEMS after an average of 3 endoscopic sessions. No procedure-related adverse events were seen.…”

Section: Discussionmentioning

confidence: 99%

“…Repeated procedures are often needed and may not be useful in the case of extensive necrosectomy [13]. This procedure can only be performed by experienced interventional endoscopists with optimal radiological and surgical facilities in a tertiary care center [14].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Retroperitoneal Necrosectomy for Infected Pancreatic Necrosis Using a Self-Expandable Metal Stent

Patil¹,

Maydeo²,

Dalal³

et al. 2021

GE Port J Gastroenterol

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Infected walled-off pancreatic necrosis (WOPN) is a severe complication of acute pancreatitis. Surgery in these critically ill patients can be associated with increased morbidity and mortality. Hence, minimally invasive therapies have emerged as an alternative to surgery. Herein, we report a case of severe acute pancreatitis with WOPN which was treated percutaneously with a flexible endoscope through an esophageal self-expanding metal stent using a total retroperitoneal approach. Percutaneous direct endoscopic necrosectomy (p-DEN) using the retroperitoneal route improved the patient’s parameters dramatically with resolution of sepsis without the need for surgery. p-DEN using a flexible endoscope passed through a large bore metal stent shows promise in selected patients with WOPN and can be used in patients who are not ideal candidates for transmural or surgical drainage.

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“…C) Paredes de cavidad con tejido de granulación do una ruta confiable a través de stent metálico transcutáneo para realizar necrosectomía repetida retroperitoneal o transperitoneal, de acuerdo con la localización y la extensión de tejido necrótico, con posibilidad de realizarlo sin anestesia general, con sedación consciente y "bedside". 9,10…”

Section: Figura 2 Tc Axial De Abdomen Se Observa Persistencia De Colección Heterogénea En Cola De Páncreas Luego De Drenaje Percutáneosunclassified

Necrosectomía endoscópica percutánea en el manejo step-up de walled-off necrosis

Adi¹,

Dutto²,

Victoria³

et al. 2020

Acta gastroenterol. latinoam.

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The drainage of liquid pancreatic collections is complex and technically challenging as for Its technique. In recent decades, endoscopic advances have improved technical and clinical success rates with reduced complications. We present a case of a 72-year-old male patient with severe necrotizing acute pancreatitis after endoscopic papillectomy for recurrent papillary adenoma, with evolution to infected walled-off necrosis. Percutaneous drainage guided by tomography was performed with poor clinical evolution and persistence of collections, predominantly in the tail of the pancreas of solid necrotic remains and air bubbles. Due to the location of the collection and the absence of contact with the gastric wall, percutaneous endoscopic necrosectomy was performed with placement of a self-expanding esophageal metal stent with resolution of the case. This unusual technique is proposed in a step-up approach to the management of walled-off necrosis, when the percutaneous drainage is insufficient and the transgastric endoscopic approach is not possible due to the characteristics of the collection. The management of walled-off necrosis as a late complication of acute necrotizing pancreatitis suggests a step-up approach. Endoscopic necrosectomy achieves higher resolution rates with a lower complication rate, resolution time, and cavity recurrence.

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Endoscopic necrosectomy of walled-off pancreatic necrosis by large-bore percutaneus metal stent: a new opportunity?

Cited by 15 publications

References 15 publications

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

Endoscopic Retroperitoneal Necrosectomy for Infected Pancreatic Necrosis Using a Self-Expandable Metal Stent

Necrosectomía endoscópica percutánea en el manejo step-up de walled-off necrosis

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