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Pancreatic endotherapy and necrosectomy.

Abstract

OPINION STATEMENT

There has been a paradigm shift in the management of pancreatic necrosis from open surgical debridement of infected necrosis to minimally invasive interventional radiologic, laparoscopic, and endoscopic drainage/debridement techniques. A step-up approach from less invasive to the more invasive modalities is recommended. An important distinction to make is between pseudocysts and walled-off necrosis (WON), as the interventions for each are different. Endoscopic or other interventions should be delayed for at least 4 weeks for collections to encapsulate. Direct endoscopic necrosectomy (DEN) is an effective, minimally invasive option. Several variations in the technique, including the use of esophageal fully covered self-expanding metal stents (SEMS) and lumen-apposing SEMS have recently been described. The incremental effectiveness of these stents over conventional techniques needs to be studied. Dual-modality drainage with endoscopic transmural stent placement and lavage through percutaneous drains is also an effective option with low mortality and morbidity. Several minimally invasive surgical options, including video-assisted retroperitoneal debridement and sinus tract endoscopy are available and may be preferable to open surgical necrosectomy. An algorithmic, multidisciplinary management is warranted for successful outcomes. Disconnected pancreatic duct syndrome in the setting of necrotizing pancreatitis is challenging; long-term endoscopic transmural stent placement and/or distal pancreatectomy are potential treatment options.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA, Pannala.Rahul@mayo.edu.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25773605

Citation

Pannala, Rahul, and Andrew S. Ross. "Pancreatic Endotherapy and Necrosectomy." Current Treatment Options in Gastroenterology, vol. 13, no. 2, 2015, pp. 185-97.
Pannala R, Ross AS. Pancreatic endotherapy and necrosectomy. Curr Treat Options Gastroenterol. 2015;13(2):185-97.
Pannala, R., & Ross, A. S. (2015). Pancreatic endotherapy and necrosectomy. Current Treatment Options in Gastroenterology, 13(2), pp. 185-97. doi:10.1007/s11938-015-0048-9.
Pannala R, Ross AS. Pancreatic Endotherapy and Necrosectomy. Curr Treat Options Gastroenterol. 2015;13(2):185-97. PubMed PMID: 25773605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pancreatic endotherapy and necrosectomy. AU - Pannala,Rahul, AU - Ross,Andrew S, PY - 2015/3/17/entrez PY - 2015/3/17/pubmed PY - 2015/3/17/medline SP - 185 EP - 97 JF - Current treatment options in gastroenterology JO - Curr Treat Options Gastroenterol VL - 13 IS - 2 N2 - OPINION STATEMENT: There has been a paradigm shift in the management of pancreatic necrosis from open surgical debridement of infected necrosis to minimally invasive interventional radiologic, laparoscopic, and endoscopic drainage/debridement techniques. A step-up approach from less invasive to the more invasive modalities is recommended. An important distinction to make is between pseudocysts and walled-off necrosis (WON), as the interventions for each are different. Endoscopic or other interventions should be delayed for at least 4 weeks for collections to encapsulate. Direct endoscopic necrosectomy (DEN) is an effective, minimally invasive option. Several variations in the technique, including the use of esophageal fully covered self-expanding metal stents (SEMS) and lumen-apposing SEMS have recently been described. The incremental effectiveness of these stents over conventional techniques needs to be studied. Dual-modality drainage with endoscopic transmural stent placement and lavage through percutaneous drains is also an effective option with low mortality and morbidity. Several minimally invasive surgical options, including video-assisted retroperitoneal debridement and sinus tract endoscopy are available and may be preferable to open surgical necrosectomy. An algorithmic, multidisciplinary management is warranted for successful outcomes. Disconnected pancreatic duct syndrome in the setting of necrotizing pancreatitis is challenging; long-term endoscopic transmural stent placement and/or distal pancreatectomy are potential treatment options. SN - 1092-8472 UR - https://www.unboundmedicine.com/medline/citation/25773605/Pancreatic_endotherapy_and_necrosectomy_ L2 - https://dx.doi.org/10.1007/s11938-015-0048-9 DB - PRIME DP - Unbound Medicine ER -