Safety of endoscopic pancreatic necrosectomy compared with percutaneous and surgical necrosectomy: a nationwide inpatient study

Abstract

Background and Aims Pancreatic necrosis is an independent predictor of morbidity and mortality among patients with acute pancreatitis. We compared the safety and outcomes of 3 techniques including endoscopic necrosectomy, fluoroscopy-guided percutaneous necrosectomy by an interventional radiologist, and surgical necrosectomy. Methods Using the Nationwide Readmissions Database, we identified hospitalized patients who underwent pancreatic necrosectomy from 2016 to 2019. They were identified using the International Classification of Diseases, 10th Revision, Procedure Coding System. Results Of the 2,281 patients meeting the selection criteria, the method of pancreatic necrosectomy was as follows: endoscopy (n=672), percutaneous (n=1,338), and surgery (n=271). Compared to surgery, the rate of mortality was lowest for endoscopy (hazard ratio (HR) 0.27; 95% CI 0.08-0.90; P = 0.033) followed by percutaneous (HR 0.44; 95% CI, 0.20-0.98; P =0.045). Endoscopy was associated with less post-procedure bleeding compared to percutaneous and surgical necrosectomy (P<0.001), as well as lower rates of post-procedure renal failure (P<0.001) and respiratory failure (P=0.002). Endoscopy was associated with average shorter lengths of stay and total hospital costs when compared with percutaneous and surgical approaches, respectively (20.1 vs 25.8 vs 38.3 days; P <0.001) and ($57K vs $76K vs $123K; P<0.001). Conclusions Endoscopic necrosectomy is associated with significantly lower risk of inpatient mortality, adverse events, length of stay, and cost when compared to percutaneous and surgical approaches.

Indications, Techniques and Future Perspectives of Walled-off Necrosis Management

“…Overall, the mortality did not differ between groups (14.5% vs. 16.1%) [20][21][22][23]. These data boosted the use of endoscopy to manage pancreatic necrotic collection, and the endoscopic step-up approach should be adopted if the expertise is locally available [4,[24][25][26][27].…”

Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials

“…Another study of 2281 patients evaluated the management of infected necrotizing pancreatitis through surgical, endoscopic, or percutaneous approaches. The study found that the endoscopic approach was associated with the lowest risk of inpatient mortality (hazard ratio (HR) 0.27; 95% CI 0.08–0.90; p = 0.033), adverse events ( p < 0.001), length of stay ( p < 0.001), and total cost [ 42 ]. This recent study also confirms the results of our analysis.…”

Step-up approach for the treatment of infected necrotising pancreatitis: real life data from a single-centre experience with long-term follow-up

“…We and others developed minimally invasive radiological, endoscopic and surgical techniques [ 6 ] that can be included in the step-up approach and appeared finally superior to open surgery with significantly lower new-onset of OF and mortality as well as shorter hospital stay [ 7 – 12 ]. Moreover, the endoscopic approach (when possible) may be superior to minimally invasive surgical ones in term of mortality, major complications and sequels [ 13 – 16 ]. Considering these results, the “step up” approach was validated by an international consensus in 2012 and by other nationals and European consensus [ 17 – 20 ].…”