Endoscopic transmural drainage and necrosectomy in acute necrotizing pancreatitis: A review

Abstract

Acute necrotizing pancreatitis occurs in 10%–20% of patients with acute pancreatitis (AP) which is one of the most important acute abdominal diseases that require hospital admission. Pancreatic necrosis is also associated with high mortality and morbidity. In the past 20 years, the treatment of pancreatic necrosis has shifted from open necrosectomy to minimally invasive techniques, such as endoscopic interventions. With the development of endoscopic techniques, the safety and effectiveness of endoscopic interventions have improved, but there exist several unresolved problems. Currently, there is no unified standard approach for endoscopic treatment of pancreatic necrosis that takes into account local expertise, anatomical features of necrosis, patients’ preferences, and comorbidity profile. We reviewed the current status of endoscopic therapy for acute necrotizing pancreatitis, focusing on the new endoscopic drainage technique and necrosectomy protocol.

Percutaneous endoscopic necrosectomy (PEN) for treatment of necrotizing pancreatitis: a systematic review and meta-analysis

“…Unfortunately, in review, factors indicating time of intervention during patient’s clinical course including onset of pancreatic necrosis and percent necrosis were not uniformly discussed across previously published literature. As aforementioned, commonly FCSEMS, LAMS, and plastic stents have commonly been utilized, but studies have been limited comparing clinical efficacy, safety, leading to inconsistent results 40 . Minimally invasive drainage via step-up approach, VARD and PEN, has shown superior drainage, debridement in comparison to frank surgical approach with regard to complications and long-term morbidity with no paper reporting direct comparison.…”

“…Unfortunately, in review, factors indicating time of intervention during patient's clinical course including onset of pancreatic necrosis and percent necrosis were not uniformly discussed across previously published literature. As aforementioned, commonly FCSEMS, LAMS, and plastic stents have commonly been utilized, but studies have been limited comparing clinical efficacy, safety, leading to inconsistent results [40].…”

Advancements of molecular imaging and radiomics in pancreatic carcinoma

“…Different imaging techniques have their advantages and disadvantages, and their combined application can achieve complementary advantages and improve the value of clinical applications[ 58 ]. In addition, the management of radiopharmaceuticals is extremely strict in some countries, and very few radiopharmaceuticals are clinically approved.…”

Endoscopic management of pancreatic walled-off necrosis

“…The AGA regards this practice as an appropriate technique in patients who do not respond appropriately to EUS-guided drainage, and it is best used in patients who have limited necrosis [ 12 ]. Studies have illustrated that DEN has high clinical success rates [ 33 - 35 ] ( Fig. 2 ).…”