Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary?

Jürgensen, Christian; Neser, Frank; Boese-Landgraf, J.; Schuppan, Detlef; Stölzel, Ulrich; Fritscher-Ravens, Annette

doi:10.1007/s00464-011-2039-9

Cited by 37 publications

(11 citation statements)

References 18 publications

(34 reference statements)

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“…The largest study, which included 639 patients from the Netherlands, reported that the predominant cause of necrotizing pancreatitis was biliary factors (48%), followed by alcohol consumption (24%), and unknown factors (19%) . Based on our review of the literature, the leading causes of acute pancreatitis resulting in WON were biliary factors (median 40%, range 14–81%), alcohol consumption (median 27%, range 2–70%), and idiopathic factors (median 14%, range 4–45%) …”

Section: Consensus Statementsmentioning

confidence: 98%

Asian consensus statements on endoscopic management of walled‐off necrosis Part 1: Epidemiology, diagnosis, and treatment

Isayama

Nakai

Rerknimitr

et al. 2016

J of Gastro and Hepatol

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Walled-off necrosis (WON) is a relatively new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 1 of this statement focused on the epidemiology, diagnosis, and timing of intervention.Author contributions: HI was involved with study conception, study design, creation of the preliminary statements list and the allocated statement, drafting of the manuscript, critical revision of the manuscript, obtaining funding, face-to-face meetings, and voting. YN, NY, RR, and CK were involved with creation of the preliminary statements list and the allocated statement, drafting of the manuscript, critical revision of the manuscript, face-to-face meetings, and voting. All authors were involved with creation of the allocated statement, drafting of the manuscript, critical revision of the manuscript, obtaining funding, face-to-face meetings, and voting.

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Section: Consensus Statementsmentioning

confidence: 98%

Asian consensus statements on endoscopic management of walled‐off necrosis Part 1: Epidemiology, diagnosis, and treatment

Isayama

Nakai

Rerknimitr

et al. 2016

J of Gastro and Hepatol

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“…External drainage can be used for monitoring adequate drainage and for irrigation. However, no studies have demonstrated the efficacy of external drainage . Given the discomfort associated with a nasocystic tube, routine use cannot be recommended.…”

Section: Resultsmentioning

confidence: 99%

“…However, no studies have demonstrated the efficacy of external drainage. 25 Given the discomfort associated with a nasocystic tube, routine use cannot be recommended. Multiple gateway 26 or dual modality 27 (combined percutaneous and endoscopic drainage) techniques may be viable alternatives.…”

Section: Quality Of Evidence: Ii-3mentioning

confidence: 99%

Asian consensus statements on endoscopic management of walled‐off necrosis. Part 2: Endoscopic management

Isayama

Nakai

Rerknimitr

et al. 2016

J of Gastro and Hepatol

View full text Add to dashboard Cite

Walled‐off necrosis (WON) is a new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high‐quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 2 of this statement focused on the endoscopic management of WON.

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“…An über 100 Patienten mit Zysten und Nekrosen wurde auf einem Poster gezeigt, dass eine über die transmurale Drainage in den Gastrointestinaltrakt hinausgehende zusätzliche Spülbehandlung ohne signifikanten Einfluss auf den weiteren Verlauf ist [38]. Zum gleichen Schluss kam unserer Arbeitsgruppe in einer Arbeit, die in diesem Jahr publiziert wurde [39]. Mehrere Arbeiten beschäftigten sich mit der Anwendung von selbstexpandierenden Metallstents bei Pankreaszysten und nekrotisierender Pankreatitis.…”

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DDW 2012 – Eine Nachlese mit Schwerpunkt Endosonografie

Jürgensen¹

2012

Endo heute

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Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary?

Abstract: Neither endoscopic nor external flushing is needed for successful endoscopic treatment of symptomatic necroses. Even without irrigation, the outcome for patients treated with endoscopic necrosectomy is comparable to that described in the published data.

Cited by 37 publications

References 18 publications

Asian consensus statements on endoscopic management of walled‐off necrosis Part 1: Epidemiology, diagnosis, and treatment

Asian consensus statements on endoscopic management of walled‐off necrosis Part 1: Epidemiology, diagnosis, and treatment

Asian consensus statements on endoscopic management of walled‐off necrosis. Part 2: Endoscopic management

DDW 2012 – Eine Nachlese mit Schwerpunkt Endosonografie

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