Endoscopic transmural drainage tailored to quantity of necrotic debris versus laparoscopic transmural internal drainage for walled-off necrosis in acute pancreatitis: A randomized controlled trial

Angadi, Suryalok; Mahapatra, Soumya Jagannath; Sethia, Rahul; Elhence, Anshuman; Krishna, Asuri; Gunjan, Deepak; Prajapati, Om Prakash; Kumar, Subodh; Bansal, Virinder Kumar; Garg, Pramod Kumar

doi:10.1016/j.pan.2021.06.006

Cited by 17 publications

(17 citation statements)

References 24 publications

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“…Recent randomized controlled trials (RCTs) even showed that an endoscopic step-up approach resulted in lower rates of complications and shorter hospital stays when compared to a (minimally invasive) surgical step-up approach [ 7 , 8 ]. Other recently published RCTs [ 9 , 10 ] have found similar technical success rates when comparing an endoscopic with a laparoscopic drainage approach, while again, the endoscopic approach resulted in shorter hospital stays in one of the reports [ 10 ]. Therefore, endoscopic treatment currently represents the treatment modality of choice when drainage of pancreatic necrosis is indicated.…”

Section: Introductionmentioning

confidence: 85%

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Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study

Frost

Schlesinger

Wiese

et al. 2022

JCM

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Pancreatic necroses are a major challenge in the treatment of patients with pancreatitis, causing high morbidity. When indicated, these lesions are usually drained endoscopically using plastic or metal stents. However, data on factors associated with the occurrence of failure or adverse events during stent therapy are scarce. We retrospectively analyzed all adverse events and their associated features which occurred in patients who underwent a first-time endoscopic drainage of pancreatic necrosis from 2009 to 2019. During the observation period, a total of 89 eligible cases were identified. Adverse events occurred in 58.4% of the cases, of which 76.9% were minor (e.g., stent dislocation, residual lesions, or stent obstruction). However, these events triggered repeated interventions (63.5% vs. 0%, p < 0.001) and prolonged hospital stays (21.0 [11.8–63.0] vs. 14.0 [7.0–31.0], p = 0.003) compared to controls without any adverse event. Important factors associated with the occurrence of adverse events during endoscopic drainage therapy were positive necrosis cultures (6.1 [2.3–16.1], OR [95% CI], p < 0.001) and a larger diameter of the treated lesion (1.3 [1.1–1.5], p < 0.001). Superinfection of pancreatic necrosis is the most significant factor increasing the likelihood of adverse events during endoscopic drainage. Therefore, control of infection is crucial for successful drainage therapy, and future studies need to consider superinfection of pancreatic necrosis as a possible confounding factor when comparing different therapeutic modalities.

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Section: Introductionmentioning

confidence: 85%

“…The choice of LAMS or plastic stents could be made according to the amount of necrotic debris in the target lesion, with LAMS used only for lesions with a large proportion of solid components. This approach has been applied in a recently published RCT [ 10 ], achieving similar success rates compared to a laparoscopic drainage approach.…”

Section: Discussionmentioning

confidence: 99%

Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study

Frost

Schlesinger

Wiese

et al. 2022

JCM

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“…Endoscopic drainage should also be considered for necrotic fluid collections. 7 Endoscopic drainage always requires that the cyst is mature and organized.…”

Section: Discussionmentioning

confidence: 99%

“…Outcomes are generally superior for cysts located in the pancreatic head and/or small cysts. Endoscopic drainage should also be considered for necrotic fluid collections 7. Endoscopic drainage always requires that the cyst is mature and organized.…”

Section: Treatmentmentioning

confidence: 99%

Imaging Features of Acute Pancreatitis and the Revised Atlanta Classification System

Bui¹,

Seidler²

2023

Contemporary Diagnostic Radiology

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Acute pancreatitis is a major cause of hospital admissions in the United States, with the two primary causes being gallstones and alcohol.1 The Atlanta classification system is an international classification on the severity of acute pancreatitis. In 2012, deficiencies and outdated nomenclature were removed to make a revised system that take into account advancements in research and clinical management. The revised Atlanta classification system (RACS) in 2012 standardized the nomenclature for acute pancreatitis and local complications to facilitate effective communication between clinicians and radiologists alike. Older terms such as pancreatic abscess, phlegmon, acute pseudocyst, and fluid collection are no longer used, as they are vague and can be misleading.

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“…Two randomized trials have shown that endoscopic and laparoscopic internal drainage provide similar success and complications rates in patients with walled-off necrosis. 15,16 Video-assisted retroperitoneal debridement by design requires a 5-cm surgical incision for debridement and is not necessarily a minimally invasive procedure. A conceptually similar but minimally invasive technique is percutaneous endoscopic necrosectomy for laterally placed necrotic collections.…”

mentioning

confidence: 99%

Navigating the Stormy Sea of Infected Necrotizing Pancreatitis: Are We There Yet? Well Almost!

Mahapatra

Garg

2022

Gastroenterology

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Endoscopic transmural drainage tailored to quantity of necrotic debris versus laparoscopic transmural internal drainage for walled-off necrosis in acute pancreatitis: A randomized controlled trial

Cited by 17 publications

References 24 publications

Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study

Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study

Imaging Features of Acute Pancreatitis and the Revised Atlanta Classification System

Navigating the Stormy Sea of Infected Necrotizing Pancreatitis: Are We There Yet? Well Almost!

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