Factors impacting treatment outcomes in the endoscopic management of walled‐off pancreatic necrosis

Abstract

Background Treatment outcomes are suboptimal for patients undergoing endoscopic treatment of walled-off pancreatic necrosis (WOPN). The objective of this study is to identify factors that impact treatment outcomes in this patient subset. Methods This is a retrospective study of patients with WOPN treated endoscopically over 10 years. Patients underwent placement of stents and nasocystic catheters within the necrotic cavity. In select patients, the multiple transluminal gateway technique (MTGT) was adopted to create several openings in the stomach or duodenum to facilitate drainage of necrosis. In patients with disconnected pancreatic duct syndrome (DPDS), the transmural stents were left in place indefinitely to decrease pancreatic fluid collection (PFC) recurrence. Results Endoscopic treatment was successful in 53 of 76 (69.7%) patients. Treatment success was higher in patients undergoing MTGT than in those in whom conventional drainage was used (94.4% vs 62.1%, P = 0.009). On multivariate logistic regression analysis, only MTGT (OR 15.8, 95% CI 1.77–140.8; P = 0.01) and fewer endoscopic sessions being needed (OR 4.0, 95% CI 1.16–14.0; P = 0.03) predicted treatment success. PFC recurrence was significantly lower in patients with indwelling transmural stents than in patients in whom the stents were removed (0 vs 20.8%; P = 0.02). Conclusions Creating multiple gateways for drainage of necrotic debris improves treatment success, and not removing the transmural stents decreases PFC recurrence in patients undergoing endoscopic drainage of WOPN.

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

“…For WOPN between 6-12 cm only one transluminal tract and those between 12 and 15 cm atleast 2 transmural tract and those more than 15 cm multiple tracts (3)(4)(5)(6) are made. An 18 Fr nasogastric tube is placed in cranial part of collection to help irrigation [62] . Combination of transluminal and percutaneous drainage techniques can help in accessing all the subcavities in certain cases.…”

Disconnected pancreatic duct syndrome: a multidisciplinary management dilemma

“…Many of those surgical procedures are associated with a high level of mortality and morbidity represented by infection, chronic pancreatic insufficiency, necrosis, multiorgan failure and death 10 11. Our patient underwent Roux-en-Y internal drainage pancreaticogastrostomy and not distal pancreaticosplenectomy for two main reasons.…”

A demarkált pancreasnecrosis kezelése. Irodalmi áttekintés

“…Mások water-jet technikát alkalmaznak a necrectomia elvégzéséhez [19]. A kezelés korlátait jelenti a kiterjedt, a retrocolicus terekbe is beterjedő necrosis, amely endoszkóposan nem mindig elérhető és kezelhető, valamint a túl nagy töme-gű necroticus szövet [1,11,17,20,32,35,37,46,47,58]. Mások csak nagyobb mennyiségű folyadék jelenlé-tekor javasolják a beavatkozást [46].…”

“…Az endoszkópos kezelés szövődménye lehet vérzés, szabad hasűri perforáció, valamint CO 2 -embolisatio [1,5,14,20,21,27,28,32,35,47,55,57]. A szövőd-mények mintegy 26-44%-ra, a halálozás 5,8-11,0%-ra tehető [5,11,14,17,20,21,27,28,30,35,55].…”

“…A szövőd-mények mintegy 26-44%-ra, a halálozás 5,8-11,0%-ra tehető [5,11,14,17,20,21,27,28,30,35,55]. Az endoszkópos kezelés sikertelensége és súlyosabb szövőd-mény esetén sebészi beavatkozás válhat szükségessé [10,21,28,35,37,47,51,55].…”