Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study

Yasuda, Ichiro; Nakashima, Masanori; Iwai, Tomohisa; Isayama, Hiroyuki; Itoi, Takao; Hisai, Hiroyuki; Inoue, H.; Kato, Hironari; Kanno, Atsushi; Kubota, Kaori; Irisawa, Atsushi; Igarashi, Hisato; Okabe, Yoshinobu; Kitano, Masayuki; Kawakami, Hiroshi; Hayashi, Takuhiro; Mukai, Tsuyoshi; Sata, Naohiro; Kida, Mitsuhiro; Shimosegawa, Tooru

doi:10.1055/s-0033-1344027

Cited by 143 publications

(118 citation statements)

References 14 publications

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“…Similar outcomes have been observed in subsequent studies [47,48], and a recent meta-analysis found pooled rates of treatment success, complications and mortality of 81%, 35% and 6%, respectively [49]. Reported complications include perforation, air embolism, and bleeding, which occurs in 3%–21% of patients [46,47,50]. Therefore, despite the fact that DEN may contribute to accelerated patient recovery and clinical resolution of infected WON, the morbidity and mortality associated with the procedure should limit its use to circumstances in which patients have failed to improve after appropriate transluminal drainage, with a target treatment endpoint of clinical resolution of significant symptoms, not radiological resolution.…”

Section: Direct Endoscopic Necrosectomysupporting

confidence: 92%

“…Despite these encouraging results, complications were common, occurring in 26% of patients, with 7.5% mortality. Similar outcomes have been observed in subsequent studies [47,48], and a recent meta-analysis found pooled rates of treatment success, complications and mortality of 81%, 35% and 6%, respectively [49]. Reported complications include perforation, air embolism, and bleeding, which occurs in 3%–21% of patients [46,47,50].…”

Section: Direct Endoscopic Necrosectomysupporting

confidence: 77%

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Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

et al. 2017

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Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.

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Section: Direct Endoscopic Necrosectomysupporting

confidence: 92%

Section: Direct Endoscopic Necrosectomysupporting

confidence: 77%

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

et al. 2017

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“…15,16 In addition to these therapies, endoscopic necrosectomy for infected, walled-off pancreatic necrosis has been developed, which enables effective intervention with morbidity and mortality lower than does surgical necrosectomy. 17,18 The contribution of this less invasive intervention to the improved prognosis of patients with AP also needs to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Nationwide Epidemiological Survey of Acute Pancreatitis in Japan

Hamada¹,

Masamune²,

Kikuta³

et al. 2014

Pancreas

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“…In the present era, endoscopic necrosectomy is preferred over open or minimally invasive surgical necrosectomy. A number of studies have established the safety and efficacy of DEN[60-62]. Endoscopic necrosectomy is associated with reduced formation of pancreatic fistula as compared to surgical drainage[10].…”

Section: Direct Endoscopic Necrosectomymentioning

confidence: 99%

Endoscopic management of pancreatic fluid collections-revisited

Nabi

Basha

Reddy

2017

WJG

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The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.

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Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study

Cited by 143 publications

References 14 publications

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

Nationwide Epidemiological Survey of Acute Pancreatitis in Japan

Endoscopic management of pancreatic fluid collections-revisited

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