Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study)

Abstract

Background: As with endoscopic transmural drainage of peripancreatic fluid collections, the same transluminal access can be expanded to introduce an endoscope through the gastrointestinal wall into the retroperitoneum and remove infected pancreatic necroses under direct visual control. This study reports the first large series with long-term follow-up. Methods: Data for all patients undergoing transluminal endoscopic removal of (peri)pancreatic necroses between 1999 and 2005 in six different centres were collected retrospectively, and the patients were followed up prospectively until 2008. The initial patient and treatment outcome data were recorded, as were long-term results. Results: Ninety-three patients (63 men, 30 women; mean age 57 years) underwent a mean of six interventions starting at a mean of 43 days after an attack of severe acute pancreatitis. After establishment of transluminal access to the necrotic cavity and subsequent endoscopic necrosectomy, initial clinical success was obtained in 80% of the patients, with a 26% complication and a 7.5% mortality rate at 30 days. After a mean follow-up period of 43 months, 84% of the initially successfully treated patients had sustained clinical improvement, with 10% receiving further endoscopic and 4% receiving surgical treatment for recurrent cavities; 16% suffered recurrent pancreatitis. Conclusions: Direct transluminal endoscopic removal of pancreatic necroses is associated with good long-term maintenance of the high initial efficacy; complications can occur, with an associated mortality of around 7.5%. Further studies are necessary in order to optimise endotherapy and define its role in relation to surgery in the clinical management of such patients.

Video-Assisted Retroperitoneal Debridement (VARD) of Infected Necrotizing Pancreatitis: An Update

“…ETN can also be performed as a step-up approach consisting of endoscopic transluminal drainage as a first step followed, if necessary, by ETN. All scores are converted to a 0-10 scale, with 10 reflecting the highest methodological score Several observational studies have been published on ETN [4,[40][41][42]. Results of reported studies are promising with a complication and mortality rate of 37 and 6 %, respectively.…”

Changes in the Management of Treatment in Acute Pancreatitis Patients

“…The endoscopic drainage of sterile pancreatic necrosis using several transgastric and transduodenal catheters combined with a nasopancreatic catheter to lavage the necrotic cavity described Baron in 1996(Baron et al, 1996. Using endoscopic drainage, many authors reported a high percentage of patients, who were treated without the need of surgery (Baron et al, 2002, Seifert et al, 2009, Seewald, 2005. Recently also minimally invasive necrosectomy techniques have been used with some promising results.…”

Trocar-assisted endoscopic retroperitoneal debridement. Non-NOTES salvage therapy for severe necrotizing pancreatitis

“…1 a, b). Percutaneous and transgastric drainage (twice each) did not resolve the solid calcified infected material (vancomycin-resistant enterococci, Staphylococcus epidermidis, Neisseria subflava, Haemophilus influenzae, Candida albicans), which could not be adequately accessed transluminally [1]. Laparotomy was deemed too risky for this moribund patient (30-kg loss of body weight), who had persistent sepsis 9 weeks after presentation.…”