Endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticocolonic fistula

Jagielski, Mateusz; Smoczyński, Marian; Adrych, Krystian

doi:10.1007/s00464-018-6032-4

Cited by 8 publications

(19 citation statements)

References 30 publications

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“…Interventional treatment is necessary for patients with clinical symptoms (including infection of necrosis) resulting from the presence of the necrotic collection [3–9]. Combination of several minimally invasive methods of treatment, allowing multiple access to the necrotic collection, is an optimal strategy for treatment of WOPN [3–9, 24–26]. Widening of the access to necrotic areas provides better drainage conditions and increases the efficiency of treatment [3–9, 24–26].…”

Section: Discussionmentioning

confidence: 99%

“…Combination of several minimally invasive methods of treatment, allowing multiple access to the necrotic collection, is an optimal strategy for treatment of WOPN [3–9, 24–26]. Widening of the access to necrotic areas provides better drainage conditions and increases the efficiency of treatment [3–9, 24–26]. The key to successful treatment of WOPN is the creation of an appropriate irrigation system that enables aggressive active drainage, and providing passive drainage in the later phase [3–9, 24–28].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous regression of asymptomatic walled-off pancreatic necrosis

Jagielski¹,

Smoczyński²,

Studniarek³

et al. 2019

aoms

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IntroductionAsymptomatic walled-off pancreatic necrosis (WOPN) should be treated conservatively, irrespective of the extent and size of the necrosis. The aim of this study was to evaluate the efficacy and safety of a strategy involving the observation of patients with asymptomatic WOPN over a long period of time.Material and methodsThis study involved the retrospective analysis of 368 patients hospitalized in our department between 2010 and 2016, due to acute pancreatitis and its consequences in the form of pancreatic and peripancreatic fluid collection.ResultsWalled-off pancreatic necrosis was identified in 168/368 (46%) patients. 124/168 (74%) patients with WOPN required interventional treatment due to clinical symptoms arising from the presence of the WOPN. Asymptomatic WOPN was identified in 44/168 (26%) patients. The mean observation time of patients with asymptomatic WOPN was 417.02 days (range: 47–1149 days). Only 1 out of the 44 patients (2%) failed to complete the follow-up. Complete regression of WOPN occurred in 30/44 (68%) patients. The presence of symptoms related to WOPN were identified in 13/44 (30%) patients during the observation. The most frequent indication for interventional treatment of WOPN was infection of the pancreatic necrosis, which was identified in 6/13 patients (46%). Altogether, 137/168 (82%) patients with WOPN required interventional treatment.ConclusionsThe majority of patients with WOPN required interventional treatment. This study provided evidence to support the view that careful observation of patients with asymptomatic WOPN is an efficient and safe treatment strategy. Long-term observation of such patients showed that most will experience spontaneous regression of asymptomatic WOPN without any other form of interventional treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous regression of asymptomatic walled-off pancreatic necrosis

Jagielski¹,

Smoczyński²,

Studniarek³

et al. 2019

aoms

Self Cite

View full text Add to dashboard Cite

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“…The main condition that must be met to start interventional treatment of AP complications in the form of pancreatic and peripancreatic fluid collection is an infection of that collection [10][11][38][39][40]. Interventional treatment is also reserved for patients with clinical symptoms of the presence of fluid collection [10][11][38][39]. They are compression symptoms such as obstructive jaundice or ileus [10][11][39][40].…”

Section: Discussionmentioning

confidence: 99%

“…Interventional treatment is also reserved for patients with clinical symptoms of the presence of fluid collection [10][11][38][39]. They are compression symptoms such as obstructive jaundice or ileus [10][11][39][40]. Patients with pancreatic fluid collections without clinical symptoms should not be treated interventionally [10][11]41], because as we have presented in our study, these collections are susceptible to spontaneous regression during the hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…In the last decades we can observe an intensive development of minimally invasive treatment methods of consequences of AP [22][23][24][26][27][38][39][40][41][42][43][44][45]. The application of interventional methods of treatment was presented in our previous publications [38][39][40][41][42]. In the presented sample interventional treatment was needed in 46/202 (22.77%) patients with pancreatic and peripancreatic fluid collections, because of persistent symptoms related with fluid collection.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and epidemiological aspects of acute pancreatitis - 10 years of single-center experience

Jagielski¹,

Kijowski²,

Fruczek³

et al. 2019

Eur J Trans Clin Med

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Background: We can observe an increase in acute pancreatitis (AP) incidence in the recent years. Materials and methods: Retrospective clinical data analysis of 370 patients with AP, hospitalized between 2007 and 2016 at our Department. Results: AP was diagnosed during 406 hospitalisation in 370 patients [average age 52.15 (21-93), 237(64.05%) male]. AP of high clinical severity was diagnosed in 60/370 (16.22%) patients. Average time of hospitalisation was 16.13 (1-121) days. Mortality was 12/406 (2.96%). The after effect of AP in form of parapancreatic fluid reservoirs was diagnosed in 202/406 (54.59%) cases. Comparing the early phase of the study (2007-2011) and the later one (2012-2016) a shorter time of hospitalisation was proven and a lower mortality of the patients in the later phase of the study. Analysis of patients' blood tests revealed that patients with severe AP have significantly elevated levels of inflammatory parameters and amylase comparing to group with mild and moderate AP, during the first days of hospitalisation. Conclusion: The development of conservative treatment options for AP, especially in early stages of the illness, has significantly shortened the duration of hospitalisation of patients with AP at our Department.

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The role of endoscopic treatment of pancreatic duct disruption in patients with walled-off pancreatic necrosis

2018

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MPD disruption occurs in the majority of patients with WON. Partial disruption of the MPD is more frequent than complete disruption of the duct. This study conducted on a large group of patients demonstrated that prosthesis insertion into the MPD in patients with disruption of the MPD in the course of ANP is one of the key elements in endoscopic treatment of WON. Passive transpapillary drainage is an effective method of treating MPD disruptions, which improves long-term outcomes of endoscopic treatment in patients with WON.

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Endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticocolonic fistula

Abstract: Background Pancreaticocolonic fistulas (PCFs) are serious complication of acute pancreatitis related with high mortality. The aim of this study was to evaluate the efficiency and safety of endoscopic treatment in patients with walled-off pancreatic necrosis (

Cited by 8 publications

References 30 publications

Spontaneous regression of asymptomatic walled-off pancreatic necrosis

Spontaneous regression of asymptomatic walled-off pancreatic necrosis

Clinical and epidemiological aspects of acute pancreatitis - 10 years of single-center experience

The role of endoscopic treatment of pancreatic duct disruption in patients with walled-off pancreatic necrosis

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