TY - JOUR
T1 - Endoscopic Necrosectomy Through Percutaneous Self-Expanding Metal Stents May Be a Promising Additive in Treatment of Necrotizing Pancreatitis
AU - Thorsen, Andreas
AU - Borch, Anders Malthe
AU - Novovic, Srdan
AU - Schmidt, Palle Nordblad
AU - Gluud, Lise Lotte
PY - 2018
Y1 - 2018
N2 - Background: The recommended treatment of infected walled-off necrosis (WON) in necrotizing pancreatitis entails a step-up treatment approach starting with endoscopic necrosectomy (ETDN). Aims: To report a small number of cases from 2013 to 2016 that were not amenable to or failed to respond to ETDN, and to describe a new, minimally invasive technique that may be a promising supplement to ETDN in this difficult patient population. Methods: Using the Seldinger technique, a fully covered self-expanding metal stent (SEMS) was placed percutaneously in order to drain, irrigate, and debride WON. After resolution, the stent was removed. We reviewed electronic patient records and defined clinical success as complete WON resolution with removal of internal as well as percutaneous drains and stents. Results: Five patients underwent treatment with SEMS placement. The mean length of the WON was 33.4 cm. Clinical success was achieved in four patients after an average of 5.75 necrosectomy sessions. One patient died from severe sepsis. Adverse events included severe abdominal pain and productive cutaneous fistulae (two patients). Conclusions: In our small case series, endoscopic necrosectomy through a percutaneous SEMS seemed beneficial and safe in the treatment of infected WON.
AB - Background: The recommended treatment of infected walled-off necrosis (WON) in necrotizing pancreatitis entails a step-up treatment approach starting with endoscopic necrosectomy (ETDN). Aims: To report a small number of cases from 2013 to 2016 that were not amenable to or failed to respond to ETDN, and to describe a new, minimally invasive technique that may be a promising supplement to ETDN in this difficult patient population. Methods: Using the Seldinger technique, a fully covered self-expanding metal stent (SEMS) was placed percutaneously in order to drain, irrigate, and debride WON. After resolution, the stent was removed. We reviewed electronic patient records and defined clinical success as complete WON resolution with removal of internal as well as percutaneous drains and stents. Results: Five patients underwent treatment with SEMS placement. The mean length of the WON was 33.4 cm. Clinical success was achieved in four patients after an average of 5.75 necrosectomy sessions. One patient died from severe sepsis. Adverse events included severe abdominal pain and productive cutaneous fistulae (two patients). Conclusions: In our small case series, endoscopic necrosectomy through a percutaneous SEMS seemed beneficial and safe in the treatment of infected WON.
KW - Acute pancreatitis
KW - Infection
KW - Necrosectomy
KW - Percutaneous endoscopic necrosectomy
KW - Walled-off necrosis
KW - WON
U2 - 10.1007/s10620-018-5131-3
DO - 10.1007/s10620-018-5131-3
M3 - Journal article
C2 - 29796908
AN - SCOPUS:85047248088
SN - 0163-2116
VL - 63
SP - 2456
EP - 2465
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 9
ER -