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Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique.
Surg Endosc. 2016 06; 30(6):2592-602.SE

Abstract

BACKGROUND

Endoscopic management of walled-off pancreatic necrosis (WOPN) is an area of great interest with many still unanswered questions, including the role of mechanical necrosectomy versus irrigation. The aim of this study was to evaluate a new method of endoscopic transmural necrosectomy.

METHODS

Patients with WOPN after necrotizing pancreatitis, who underwent endoscopic transmural necrosectomy using a lumen-apposing metal stent with vigorous irrigation sessions, were prospectively recruited between September 2011 and August 2014. Initial endoscopic session was performed by EUS-guided drainage and lavage sessions by flushing saline through the stent. Technical and clinical success rates, number of repeat interventions, and adverse events were analyzed.

RESULTS

Twelve patients with 13 WOPN collections (median size 12.4 ± 2.94 cm) underwent endoscopic treatment. Clinical success was achieved in 100 % of cases after a median of three sessions per patient (range 2-8). The median length of hospitalization was 15.9 days. Median procedure time of the access session was 31 ± 10.16 min. No adverse events (AE) were described during the procedures or 24 h after. There were four AE (two infections and two bleedings) between sessions, but only two were severe (16.6 %). There was no need for surgery, and no mortalities occurred. Mean time to stent retrieval was 9 ± 3.4 weeks. Mean follow-up was 13 months with only one recurrence at 12 months after stent removal.

CONCLUSIONS

This new variant of irrigation endoscopic transmural necrosectomy without mechanical debridement helps to simplify the technique, is feasible, and has excellent outcomes in WOPN treatment.

Authors+Show Affiliations

Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain. jgornals@bellvitgehospital.cat.Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain.Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain.Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain.Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.Department of Anesthesiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26335077

Citation

Gornals, Joan B., et al. "Endoscopic Necrosectomy of Walled-off Pancreatic Necrosis Using a Lumen-apposing Metal Stent and Irrigation Technique." Surgical Endoscopy, vol. 30, no. 6, 2016, pp. 2592-602.
Gornals JB, Consiglieri CF, Busquets J, et al. Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique. Surg Endosc. 2016;30(6):2592-602.
Gornals, J. B., Consiglieri, C. F., Busquets, J., Salord, S., de-la-Hera, M., Secanella, L., Redondo, S., Pelaez, N., & Fabregat, J. (2016). Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique. Surgical Endoscopy, 30(6), 2592-602. https://doi.org/10.1007/s00464-015-4505-2
Gornals JB, et al. Endoscopic Necrosectomy of Walled-off Pancreatic Necrosis Using a Lumen-apposing Metal Stent and Irrigation Technique. Surg Endosc. 2016;30(6):2592-602. PubMed PMID: 26335077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique. AU - Gornals,Joan B, AU - Consiglieri,Claudia F, AU - Busquets,Juli, AU - Salord,Silvia, AU - de-la-Hera,Meritxell, AU - Secanella,Lluis, AU - Redondo,Susana, AU - Pelaez,Nuria, AU - Fabregat,Joan, Y1 - 2015/09/03/ PY - 2014/12/26/received PY - 2015/08/03/accepted PY - 2015/9/4/entrez PY - 2015/9/4/pubmed PY - 2017/7/18/medline KW - Endoscopic necrosectomy KW - Necrotizing pancreatitis KW - Self-expanding metal stent KW - Transmural drainage KW - Walled-off pancreatic necrosis SP - 2592 EP - 602 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 6 N2 - BACKGROUND: Endoscopic management of walled-off pancreatic necrosis (WOPN) is an area of great interest with many still unanswered questions, including the role of mechanical necrosectomy versus irrigation. The aim of this study was to evaluate a new method of endoscopic transmural necrosectomy. METHODS: Patients with WOPN after necrotizing pancreatitis, who underwent endoscopic transmural necrosectomy using a lumen-apposing metal stent with vigorous irrigation sessions, were prospectively recruited between September 2011 and August 2014. Initial endoscopic session was performed by EUS-guided drainage and lavage sessions by flushing saline through the stent. Technical and clinical success rates, number of repeat interventions, and adverse events were analyzed. RESULTS: Twelve patients with 13 WOPN collections (median size 12.4 ± 2.94 cm) underwent endoscopic treatment. Clinical success was achieved in 100 % of cases after a median of three sessions per patient (range 2-8). The median length of hospitalization was 15.9 days. Median procedure time of the access session was 31 ± 10.16 min. No adverse events (AE) were described during the procedures or 24 h after. There were four AE (two infections and two bleedings) between sessions, but only two were severe (16.6 %). There was no need for surgery, and no mortalities occurred. Mean time to stent retrieval was 9 ± 3.4 weeks. Mean follow-up was 13 months with only one recurrence at 12 months after stent removal. CONCLUSIONS: This new variant of irrigation endoscopic transmural necrosectomy without mechanical debridement helps to simplify the technique, is feasible, and has excellent outcomes in WOPN treatment. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/26335077/Endoscopic_necrosectomy_of_walled_off_pancreatic_necrosis_using_a_lumen_apposing_metal_stent_and_irrigation_technique_ L2 - https://dx.doi.org/10.1007/s00464-015-4505-2 DB - PRIME DP - Unbound Medicine ER -