Transgastrically placed endoscopic vacuum-assisted closure system as an addition to transgastric necrosectomy in necrotizing pancreatitis (with video)

Wedemeyer, Jochen; Kubicka, Stefan; Lankisch, Tim O.; Wirth, Thomas; Patecki, Margret; Hiß, Marcus; Manns, Michael P.; Schneider, Andrea

doi:10.1016/j.gie.2012.08.014

Cited by 17 publications

(9 citation statements)

References 11 publications

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“…The final reported potential innovation is the use of a vacuum assisted closure system, widely used in treating patients with anastomotic leaks after rectal surgery. A recent case report describes the use of this system transgastrically in two patients with infected necrotizing pancreatitis [36].…”

Section: Innovationsmentioning

confidence: 99%

Endoscopic management of walled‐off pancreatic necrosis

Voermans

Besselink

Fockens

2014

J Hepato Biliary Pancreat

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Endoscopic management of infected walled-off pancreatic necrosis is increasingly being performed. Although the role of the interventional endoscopist in treating necrotizing pancreatitis is growing, a multidisciplinary team including dedicated surgeons and interventional radiologists is a condition sine qua non for optimal patient management. Optimal management starts with a correct diagnosis with accurate description of the extent and nature of the inflammatory changes according to the recently updated criteria. This is important to consequently select the correct patients for the correct intervention at the correct interval after onset. When a decision is made to endoscopically intervene in a patient with (infected) pancreatic necrosis, the actual endoscopic technique does not differ much from the first retrospective series published a decade ago. Although endoscopic intervention for pancreatic necrosis is increasingly performed, evidence for superiority of endoscopic treatment over other techniques is still lacking. Dedicated endoscopic accessories for optimal drainage and necrosectomy are still lacking as well. This review provides an overview of current status, technique and recent innovations of endoscopic treatment of walled-off pancreatic necrosis.

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Section: Innovationsmentioning

confidence: 99%

Endoscopic management of walled‐off pancreatic necrosis

Voermans

Besselink

Fockens

2014

J Hepato Biliary Pancreat

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“…The patient underwent complex surgical and endoscopic treatment with E-VAC therapy. The endo-sponge was exchange twice and was removed after 6 days of treatment [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic vacuum-assisted closure system (E-VAC): case report and review of the literature.

Borejsza-Wysocki¹,

Szmyt²,

Bobkiewicz³

et al. 2015

Videosurgery and Other Miniinvasive Techniques

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Negative pressure wound therapy (NPWT) has become a standard in the treatment of chronic and difficult healing wounds. Negative pressure wound therapy is applied to the wound via a special vacuum-sealed sponge. Nowadays, the endoscopic vacuum-assisted wound closure system (E-VAC) has been proven to be an important alternative in patients with upper and lower intestinal leakage not responding to standard endoscopic and/or surgical treatment procedures. Endoscopic vacuum-assisted wound closure system provides perfect wound drainage and closure of various kinds of defect and promotes tissue granulation. Our experience has shown that E-VAC may significantly improve the morbidity and mortality rate. Moreover, E-VAC may be useful in a multidisciplinary approach – from upper gastrointestinal to rectal surgery complications. On the other hand, major limitations of the E-VAC system are the necessity of repeated endoscopic interventions and constant presence of well-trained staff. Further, large-cohort studies need to be performed to establish the applicability and effectiveness of E-VAC before routine widespread use can be recommended.

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“…In a series of 14 patients, Siddiqui et al reported a possible advantage in decreasing the need for mechanical debridement with no specific H 2 O 2 -related complications [37]. Another interesting report is the successful use of an endoscopic vacuum-assisted closure (EVAC) method in the treatment of two patients with infected WON and multiple failed endoscopic debridements [38]. A sponge connected to the tip of a duodenal tube that is connected to suction is placed in a necrotic cavity, and the size of the sponge is reduced as the cavity size decreases.…”

Section: Other Innovationsmentioning

confidence: 99%

Pancreatic Endotherapy and Necrosectomy

Pannala

Ross

2015

Curr Treat Options Gastro

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There has been a paradigm shift in the management of pancreatic necrosis from open surgical debridement of infected necrosis to minimally invasive interventional radiologic, laparoscopic, and endoscopic drainage/debridement techniques. A step-up approach from less invasive to the more invasive modalities is recommended. An important distinction to make is between pseudocysts and walled-off necrosis (WON), as the interventions for each are different. Endoscopic or other interventions should be delayed for at least 4 weeks for collections to encapsulate. Direct endoscopic necrosectomy (DEN) is an effective, minimally invasive option. Several variations in the technique, including the use of esophageal fully covered self-expanding metal stents (SEMS) and lumen-apposing SEMS have recently been described. The incremental effectiveness of these stents over conventional techniques needs to be studied. Dual-modality drainage with endoscopic transmural stent placement and lavage through percutaneous drains is also an effective option with low mortality and morbidity. Several minimally invasive surgical options, including video-assisted retroperitoneal debridement and sinus tract endoscopy are available and may be preferable to open surgical necrosectomy. An algorithmic, multidisciplinary management is warranted for successful outcomes. Disconnected pancreatic duct syndrome in the setting of necrotizing pancreatitis is challenging; long-term endoscopic transmural stent placement and/or distal pancreatectomy are potential treatment options.

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Transgastrically placed endoscopic vacuum-assisted closure system as an addition to transgastric necrosectomy in necrotizing pancreatitis (with video)

Cited by 17 publications

References 11 publications

Endoscopic management of walled‐off pancreatic necrosis

Endoscopic management of walled‐off pancreatic necrosis

Endoscopic vacuum-assisted closure system (E-VAC): case report and review of the literature.

Pancreatic Endotherapy and Necrosectomy

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