Transpapillary drainage of pancreatic parenchymal necrosis.

Abstract

In the last two decades the strategy of treatment of necrotizing pancreatitis has changed. Endoscopic therapy of patients with symptomatic walled-off pancreatic necrosis has a high rate of efficiency. Here we present a description of a patient with parenchymal limited necrosis of the pancreas and a disruption of the main pancreatic duct. In the treatment, active transpapillary drainage of the pancreatic necrosis (through the major duodenal papilla) was performed and insertion of an endoprosthesis into the main pancreatic duct (through the minor duodenal papilla) was applied, which enabled a bypass over the infiltration and resulted in complete resolution.

Various Endoscopic Techniques for Treatment of Consequences of Acute Necrotizing Pancreatitis: Practical Updates for the Endoscopist

“…Transpapillary drainage is an option for patients with symptomatic WOPN in whom it is impossible to perform endoscopic transmural drainage because the distance from the gastrointestinal wall to the PFC is too large (above 15 mm), and contrast spilling was observed on ERP through the pancreatic duct disruption to the WOPN [35,70,71]. Moreover, if the WOPN does not completely resolve in response to transmural drainage, and the pancreatic duct communicates with the collection during ERP, transpapillary drainage can be additionally applied in some patients [35].…”

“…In active transpapillary drainage (Figure 10a-d), the nasocystic catheter or transluminal stent is inserted through the duodenal papilla to the pancreatic duct, the distal part reaching the necrotic collection through the disruption site [70,71]. Then, the collection is flushed with saline through the drain [70][71][72].…”

“…Then, the collection is flushed with saline through the drain [70][71][72]. Active transpapillary drainage as the only access to the necrotic collection is an effective endoscopic method when the necrosis is liquefied, and the collection is not too large [70,71]. Usually, it is used alongside transmural and percutaneous drainage as part of the multiple gateway technique [31,34].…”

“…Active transpapillary drainage as a single gateway technique is rarely reported in literature and remains controversial. A study from 2015 found that transpapillary drainage can be safe and effective in patients with WOPN when transmural drainage is impossible, and the necrotic collection In active transpapillary drainage (Figure 10a-d), the nasocystic catheter or transluminal stent is inserted through the duodenal papilla to the pancreatic duct, the distal part reaching the necrotic collection through the disruption site [70,71]. Then, the collection is flushed with saline through the drain [70][71][72].…”

“…A study from 2015 found that transpapillary drainage can be safe and effective in patients with WOPN when transmural drainage is impossible, and the necrotic collection In active transpapillary drainage (Figure 10a-d), the nasocystic catheter or transluminal stent is inserted through the duodenal papilla to the pancreatic duct, the distal part reaching the necrotic collection through the disruption site [70,71]. Then, the collection is flushed with saline through the drain [70][71][72]. Active transpapillary drainage as the only access to the necrotic collection is an effective endoscopic method when the necrosis is liquefied, and the collection is not too large [70,71].…”