Tags

Type your tag names separated by a space and hit enter

Endoscopic ultrasound guided transmural drainage of walled off pancreatic necrosis using a "step - up" approach: A single centre experience.
Pancreatology 2017 Mar - Apr; 17(2):203-208P

Abstract

BACKGROUND

Walled off necrosis (WON) can be treated endoscopically using multiple transmural plastic stents or fully covered self-expandable metallic stent (FCSEMS) and direct endoscopic necrosectomy (DEN). We evaluated the efficacy of "step-up" endoscopic transmural approach for treatment of WON.

METHODS

Retrospective analysis of data of 86 patients with WON who were treated with attempted endoscopic ultrasound (EUS) guided "step up" transmural drainage during last 5 years was done. Initially multiple plastic stents were placed and patients not responding underwent FCSEMS placement and/or DEN.

RESULTS

Patients presented 10.8 ± 2.8 weeks after an acute attack of acute pancreatitis and mean size of WON was 10.7 ± 2.9 cm. EUS guided transmural drainage was technically successful in 85/86 (98.8%) patients and 70 (82.4%) were drained with multiple 7/10Fr plastic stents alone while DEN was needed in 9 (10.6%) and FCSEMS was inserted in 6 (7%) patients. All patients had successful outcome with none requiring surgery. The patients who needed DEN/FCSEMS presented earlier and had large size collection with more solid necrotic debris as compared to patients treated with multiple plastic stents alone. The complications were pneumoperitoneum (n = 1), bile leak following cholecystecomy (n = 1), development of external pancreatic fistula following percutaneous drainage (n = 1) and gastrointestinal bleed (n = 1).

CONCLUSIONS

"Step up" endoscopic transmural drainage using multiple plastic stents as an initial therapy is safe and effective treatment of WON and avoids more aggressive DEN in majority of patients. Large size WON with more necrotic debris may require DEN.

Authors+Show Affiliations

Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India. Electronic address: drsurinderrana@gmail.com.Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.Department of Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28202234

Citation

Rana, Surinder S., et al. "Endoscopic Ultrasound Guided Transmural Drainage of Walled Off Pancreatic Necrosis Using a "step - Up" Approach: a Single Centre Experience." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 17, no. 2, 2017, pp. 203-208.
Rana SS, Sharma V, Sharma R, et al. Endoscopic ultrasound guided transmural drainage of walled off pancreatic necrosis using a "step - up" approach: A single centre experience. Pancreatology. 2017;17(2):203-208.
Rana, S. S., Sharma, V., Sharma, R., Gupta, R., & Bhasin, D. K. (2017). Endoscopic ultrasound guided transmural drainage of walled off pancreatic necrosis using a "step - up" approach: A single centre experience. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 17(2), pp. 203-208. doi:10.1016/j.pan.2017.02.007.
Rana SS, et al. Endoscopic Ultrasound Guided Transmural Drainage of Walled Off Pancreatic Necrosis Using a "step - Up" Approach: a Single Centre Experience. Pancreatology. 2017;17(2):203-208. PubMed PMID: 28202234.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic ultrasound guided transmural drainage of walled off pancreatic necrosis using a "step - up" approach: A single centre experience. AU - Rana,Surinder S, AU - Sharma,Vishal, AU - Sharma,Ravi, AU - Gupta,Rajesh, AU - Bhasin,Deepak K, Y1 - 2017/02/08/ PY - 2016/10/14/received PY - 2017/02/06/revised PY - 2017/02/07/accepted PY - 2017/2/17/pubmed PY - 2017/10/6/medline PY - 2017/2/17/entrez KW - Acute pancreatitis KW - Gall stones KW - Self-expanding metallic stents KW - Transmural drainage KW - Walled off necrosis SP - 203 EP - 208 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 17 IS - 2 N2 - BACKGROUND: Walled off necrosis (WON) can be treated endoscopically using multiple transmural plastic stents or fully covered self-expandable metallic stent (FCSEMS) and direct endoscopic necrosectomy (DEN). We evaluated the efficacy of "step-up" endoscopic transmural approach for treatment of WON. METHODS: Retrospective analysis of data of 86 patients with WON who were treated with attempted endoscopic ultrasound (EUS) guided "step up" transmural drainage during last 5 years was done. Initially multiple plastic stents were placed and patients not responding underwent FCSEMS placement and/or DEN. RESULTS: Patients presented 10.8 ± 2.8 weeks after an acute attack of acute pancreatitis and mean size of WON was 10.7 ± 2.9 cm. EUS guided transmural drainage was technically successful in 85/86 (98.8%) patients and 70 (82.4%) were drained with multiple 7/10Fr plastic stents alone while DEN was needed in 9 (10.6%) and FCSEMS was inserted in 6 (7%) patients. All patients had successful outcome with none requiring surgery. The patients who needed DEN/FCSEMS presented earlier and had large size collection with more solid necrotic debris as compared to patients treated with multiple plastic stents alone. The complications were pneumoperitoneum (n = 1), bile leak following cholecystecomy (n = 1), development of external pancreatic fistula following percutaneous drainage (n = 1) and gastrointestinal bleed (n = 1). CONCLUSIONS: "Step up" endoscopic transmural drainage using multiple plastic stents as an initial therapy is safe and effective treatment of WON and avoids more aggressive DEN in majority of patients. Large size WON with more necrotic debris may require DEN. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/28202234/Endoscopic_ultrasound_guided_transmural_drainage_of_walled_off_pancreatic_necrosis_using_a_"step___up"_approach:_A_single_centre_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(17)30032-7 DB - PRIME DP - Unbound Medicine ER -