Transpapillary drainage of walled-off pancreatic necrosis - a single center experience.

Abstract

IntroductionWalled-off pancreatic necrosis (WOPN) often coexists with disruption of the main pancreatic duct that manifests as a leak of contrast medium into the necrotic collection during endoscopic retrograde pancreatography.AimTo assess the efficacy and safety of treatment of patients with symptomatic WOPN and disruption of the main pancreatic duct, who underwent endoscopic transpapillary drainage as the only access to the necrosis cavity.Material and methodsIn 22 patients with symptomatic WOPN, active endoscopic transpapillary drainage was performed. During endoscopic retrograde pancreatography (ERP), partial disruption of the main pancreatic duct was observed in 14 patients and complete disruption in 8 patients. After the active drainage was finished, a transpapillary pancreatic stent was inserted into the main pancreatic duct, which was later exchanged after 6, 12 and 24 months or when no extravasation of contrast from the pancreatic duct was observed. The results of treatment and complications were compared retrospectively.ResultsThe mean duration of active drainage was 22 (range: 7–94) days. Complications of endotherapy occurred in 3/22 patients. The mean time of the main pancreatic duct stenting was 304 (range: 85–519) days. Success of endoscopic treatment of WOPN and pancreatic duct disruption was achieved in 20/22 patients. During a 1-year follow-up, recurrence of the collection was noted in 4/20 patients. Long-term success was achieved in 16/22 patients.ConclusionsIn patients with WOPN who cannot undergo transmural drainage when there is a communication between the necrotic collection and the main pancreatic duct, transpapillary access may be an effective and safe method of treatment.

Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

“…Twenty-seven studies were retrospective in nature [2][3][4][5]8,13,14,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40], two studies were prospective in design [9,41], and one study included patients enrolled prospectively and patient data sourced retrospectively [42]. Studies were conducted in the United States (n=19) [2][3][4][5]8,9,14,22,[25][26][27][28][29]32,[35][36][37][38]41], India (n=4) [24,…”

“…Quality assessments of the studies are presented in Supplementary Table 1 and 2 in Appendix. Most studies scored between 4-6 points frequently (24/30) [2,4,5,8,9,13,[22][23][24][26][27][28][29][30][31]33,39,41,42]. Four studies scored 7-8 points [3,14,21,25].…”

Endotherapy for pancreatic necrosis: An update

“…Endoscopic stent placement is frequently successful in the transpapillary drainage of necrosis cavity. Authors have described the successful transpapillary drainage of WOPN . However, the management of a disconnected pancreatic duct syndrome in the setting of acute necrotizing pancreatitis is difficult and includes long‐term endoscopic transmural stent placement and/or distal pancreatectomy.…”

The role of transpapillary drainage in management of patients with pancreatic fluid collections and pancreatic duct disruption as a consequences of severe acute pancreatitis

“…Unfortunately, there is a small amount of publications concerning active transpapillary drainage of pancreatic fluid collections (particularly concerning walled-off pancreatic necrosis) available in recent literature. Here we would like to refer to our publication 'Transpapillary drainage of walled-off pancreatic necrosis-a single center experience' issued in 2015, where we described the results of treatment of 22 patients with symptomatic walled-off pancreatic necrosis and disruption of main pancreatic duct, who had undergone endoscopic transpapillary drainage as the only way of access to necrosis cavity [6]. Long-term success was defined as lack of clinical symptoms, lack of contrast extravasation from PD and size of the collection <3 cm in contrast-enhanced abdominal computed tomography after a one-year follow-up since the end of active drainage.…”