Transluminal endoscopic necrosectomy for pancreatic necrosis: in all hands and for all patients, or with selected endoscopists in selected patients?

Endoscopic necrosectomy of pancreatic necrosis: a systematic review

“…Air embolism was not a commonly encountered complication, but was the direct cause of one death reported by Seifert et al [14]. Although rare, because of the deadly nature of this complication, it was recommended by these authors to use carbon dioxide for insufflation rather than air [14,31].…”

Open Pancreatic Necrosectomy in the Multidisciplinary Management of Postinflammatory Necrosis

“…8 Retroperitoneal, percutaneous and endoscopic approaches to pancreatic debridement can be used with success in appropriately selected critically ill patients. 1,2,9,10 All minimally invasive approaches to necrosectomy are evolving, and there is currently insufficient evidence to advocate one approach over another. Moreover, the existing evidence demonstrates that control of infected PN without laparotomy is possible with appropriate patient selection.…”

“…[10][11][12][13][14][15][16][17][18] The choice of therapy for infected (or rarely sterile) necrosis is largely driven by local expertise. There are even reports of successful medical therapy of infected PN, although this would not be expected of a reliably effective therapy.…”

Endoscopic Pancreatic Necrosectomy

“…However, several issues require further study. Some investigators insist that EUS be used to establish transmural access, allowing for precise puncture localization, even in the absence of intraluminal bulge, as well as avoidance of vascular structures, 17 while 16 others have shown that a similar outcome can be achieved with the duodenoscope. 18 Balloon dilation of the transmural tract is safe, with large balloons required to allow for passage of the gastroscope into the cavity.…”

“…15,16,19 . Barthet and Ezzedine 17 have suggested that bleeding risk may be less by repeating the sessions more frequently as this complication tends to occur during the removal of the necrotic tissue. Prolonged endoscopic procedures may be complicated by air embolism, 16,17,20 leading to the use of carbon dioxide instead of air in some centers.…”