Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Pancreatic Necrosectomy through Sinus Tract Endoscopy

  • Goenka, Mahesh Kumar (Institute of Gastrosciences, Apollo Gleneagles Hospitals) ;
  • Goenka, Usha (Department of Clinical Imaging and Interventional Radiology, Apollo Gleneagles Hospitals) ;
  • Mujoo, Md.Yasin (Institute of Gastrosciences, Apollo Gleneagles Hospitals) ;
  • Tiwary, Indrajit Kumar (Institute of Gastrosciences, Apollo Gleneagles Hospitals) ;
  • Mahawar, Sanjay (Institute of Gastrosciences, Apollo Gleneagles Hospitals) ;
  • Rai, Vijay Kumar (Institute of Gastrosciences, Apollo Gleneagles Hospitals)
  • Received : 2017.05.06
  • Accepted : 2017.09.13
  • Published : 2018.05.30
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Abstract

Background/Aims: Direct endoscopic pancreatic necrosectomy is increasingly being utilized to treat infected or symptomatic walled-off necrosis (WON) located close to the stomach or duodenum. Laterally-placed WON has traditionally been treated surgically. We evaluated a less utilized technique of sinus tract endoscopy (STE) for symptomatic laterally-placed WON. Methods: Two hundred seventy-six patients with acute pancreatitis admitted in our hospital, 32 had symptomatic or infected WON requiring intervention. Of the 12 patients with laterally placed WON, 10 were treated by STE. STE was performed with a standard adult gastroscope passed through a percutaneous tract created by the placement of a 32-Fr drain. Results: Ten patients (7 males; mean age, 43.8 years) underwent STE. Mean number of sessions was 2.3 (range, 1-4), with mean time of 70 minutes for each session (range, 15-70 minutes). While 9 patients had complete success, 1 patient had fever and chose to undergo surgery. Two patients developed pneumoperitoneum, which was treated conservatively. There was no mortality, cutaneous fistula, or recurrence during follow-up. Conclusions: Laterally placed WON can be successfully managed by STE performed through a percutaneously placed drain. Details of the technique and end-points of STE require further evaluation.

Keywords

References

  1. Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis. Br J Surg 2009;96:267-273. https://doi.org/10.1002/bjs.6447
  2. Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 2010;139:813-820. https://doi.org/10.1053/j.gastro.2010.06.010
  3. Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med 2006;354:2142-2150. https://doi.org/10.1056/NEJMcp054958
  4. Gloor B, Muller CA, Worni M, Martignoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:975-979. https://doi.org/10.1046/j.0007-1323.2001.01813.x
  5. Garg PK, Madan K, Pande GK, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol 2005;3:159-166. https://doi.org/10.1016/S1542-3565(04)00665-2
  6. Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology. American college of gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013;108:1400-1415; 1416. https://doi.org/10.1038/ajg.2013.218
  7. Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas 2012;41:1176-1194. https://doi.org/10.1097/MPA.0b013e318269c660
  8. Werner J, Hartwig W, Hackert T, Buchler MW. Surgery in the treatment of acute pancreatitis--open pancreatic necrosectomy. Scand J Surg 2005;94:130-134. https://doi.org/10.1177/145749690509400209
  9. Baron TH, Thaggard WG, Morgan DE, Stanley RJ. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996;111:755-764. https://doi.org/10.1053/gast.1996.v111.pm8780582
  10. Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 2000;356:653-655. https://doi.org/10.1016/S0140-6736(00)02611-8
  11. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013;13(4 Suppl 2):e1-e15. https://doi.org/10.1016/j.pan.2013.07.063
  12. Larvin M. Management of infected pancreatic necrosis. Curr Gastroenterol Rep 2008;10:107-114. https://doi.org/10.1007/s11894-008-0030-y
  13. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491-1502. https://doi.org/10.1056/NEJMoa0908821
  14. Trikudanathan G, Attam R, Arain MA, Mallery S, Freeman ML. Endoscopic interventions for necrotizing pancreatitis. Am J Gastroenterol 2014;109:969-981; quiz 982. https://doi.org/10.1038/ajg.2014.130
  15. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141:1254-1263. https://doi.org/10.1053/j.gastro.2011.06.073
  16. Gluck M, Ross A, Irani S, et al. Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol 2010;8:1083-1088. https://doi.org/10.1016/j.cgh.2010.09.010
  17. Ross AS, Irani S, Gan SI, et al. Dual-modality drainage of infected and symptomatic walled-off pancreatic necrosis: long-term clinical outcomes. Gastrointest Endosc 2014;79:929-935. https://doi.org/10.1016/j.gie.2013.10.014
  18. Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012;307:1053-1061. https://doi.org/10.1001/jama.2012.276
  19. Mouli VP, Sreenivas V, Garg PK. Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis. Gastroenterology 2013;144:333-340.e2. https://doi.org/10.1053/j.gastro.2012.10.004
  20. Runzi M, Niebel W, Goebell H, Gerken G, Layer P. Severe acute pancreatitis: nonsurgical treatment of infected necroses. Pancreas 2005;30:195-199. https://doi.org/10.1097/01.mpa.0000153613.17643.b3
  21. Lee JK, Kwak KK, Park JK, et al. The efficacy of nonsurgical treatment of infected pancreatic necrosis. Pancreas 2007;34:399-404. https://doi.org/10.1097/MPA.0b013e318043c0b1
  22. Hart PA, Baron TH. What is the role of noninvasive treatment for infected pancreatic necrosis: still an unanswered question. Gastroenterology 2013;144:1574-1575. https://doi.org/10.1053/j.gastro.2013.03.054
  23. Seifert H, Biermer M, Schmitt W, et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD study). Gut 2009;58:1260-1266. https://doi.org/10.1136/gut.2008.163733
  24. Charnley RM, Lochan R, Gray H, O'Sullivan CB, Scott J, Oppong KE. Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy 2006;38:925-928. https://doi.org/10.1055/s-2006-944731
  25. Rische S, Riecken B, Degenkolb J, Kayser T, Caca K. Transmural endoscopic necrosectomy of infected pancreatic necroses and drainage of infected pseudocysts: a tailored approach. Scand J Gastroenterol 2013;48:231-240. https://doi.org/10.3109/00365521.2012.752029
  26. Escourrou J, Shehab H, Buscail L, et al. Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis. Ann Surg 2008;248:1074-1080. https://doi.org/10.1097/SLA.0b013e31818b728b
  27. Yasuda I, Nakashima M, Iwai T, et al. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study. Endoscopy 2013;45:627-634. https://doi.org/10.1055/s-0033-1344027
  28. Gardner TB. Endoscopic management of necrotizing pancreatitis. Gastrointest Endosc 2012;76:1214-1223. https://doi.org/10.1016/j.gie.2012.05.028
  29. Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg 2000;232:175-180. https://doi.org/10.1097/00000658-200008000-00004
  30. Mui LM, Wong SK, Ng EK, Chan AC, Chung SC. Combined sinus tract endoscopy and endoscopic retrograde cholangiopancreatography in management of pancreatic necrosis and abscess. Surg Endosc 2005;19:393-397. https://doi.org/10.1007/s00464-004-9120-6
  31. Dhingra R, Srivastava S, Behra S, et al. Single or multiport percutaneous endoscopic necrosectomy performed with the patient under conscious sedation is a safe and effective treatment for infected pancreatic necrosis (with video). Gastrointest Endosc 2015;81:351-359. https://doi.org/10.1016/j.gie.2014.07.060
  32. Abdelhafez M, Elnegouly M, Hasab Allah MS, Elshazli M, Mikhail HM, Yosry A. Transluminal retroperitoneal endoscopic necrosectomy with the use of hydrogen peroxide and without external irrigation: a novel approach for the treatment of walled-off pancreatic necrosis. Surg Endosc 2013;27:3911-3920. https://doi.org/10.1007/s00464-013-2948-x
  33. Bucher P, Pugin F, Morel P. Minimally invasive necrosectomy for infected necrotizing pancreatitis. Pancreas 2008;36:113-119. https://doi.org/10.1097/MPA.0b013e3181514c9e
  34. Ammori BJ. Laparoscopic transgastric pancreatic necrosectomy for infected pancreatic necrosis. Surg Endosc 2002;16:1362. https://doi.org/10.1007/s00464-001-4145-6
  35. Horvath KD, Kao LS, Ali A, Wherry KL, Pellegrini CA, Sinanan MN. Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis. Surg Endosc 2001;15:677-682. https://doi.org/10.1007/s004640080010
  36. Horvath KD, Kao LS, Wherry KL, Pellegrini CA, Sinanan MN. A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc 2001;15:1221-1225. https://doi.org/10.1007/s004640080166
  37. Freeny PC, Lewis GP, Traverso LW, Ryan JA. Infected pancreatic fluid collections: percutaneous catheter drainage. Radiology 1988;167:435-441. https://doi.org/10.1148/radiology.167.2.3357952
  38. Gambiez LP, Denimal FA, Porte HL, Saudemont A, Chambon JP, Quandalle PA. Retroperitoneal approach and endoscopic management of peripancreatic necrosis collections. Arch Surg 1998;133:66-72. https://doi.org/10.1001/archsurg.133.1.66

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