A standardized method for endoscopic necrosectomy improves complication and mortality rates

Christopher C. Thompson, Nitin Kumar, James Slattery, Thomas E. Clancy, Michele B. Ryan, Marvin Ryou, Richard S. Swanson, Peter A. Banks, Darwin L. Conwell

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

Objectives: Endoscopic necrosectomy is effective in the treatment of walled-off necrosis (WON), and is preferred to surgical approaches, however complication and mortality rates remain high with few centers regularly employing the technique. Lack of a standardized approach may also contribute to these limitations. Methods: Prior to the study, a multidisciplinary team applied standardized care assessment and management plan principles to develop and optimize a systematic approach for the management of WON. Preoperative, postoperative, and endoscopic management were standardized. Patient preparation, room set-up, technical features (EUS-guidance, cold-access with balloon dilation, fragmentation of necrosis on the initial procedure, antibiotic lavage, double pigtail stents), and discontinuation of PPIs to encourage auto-digestion of necrosis were included. This study employed a consecutive prospective clinical registry to assess the clinical outcomes of this standardized approach. Results: 60 consecutive patients underwent 1.58 ± 0.1 necrosectomies, with debridement accomplished on the initial procedure in 98.3%. 39 patients (65%) required only one session. Clinical resolution occurred in 86.7%, with radiologic confirmation. Percutaneous drainage was required in 8 patients during follow-up, and 4 of these later required surgery. Serious adverse events occurred in 3.3% of patients, and there was no mortality. Conclusions: The standardized technique employed in this series was associated with lower rates of adverse events, morbidity, and mortality than prior large series. Use of a systematic approach, and integrating elements of this method may improve the risk profile of endoscopic necrosectomy and allow broader adoption.

Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalPancreatology
Volume16
Issue number1
DOIs
StatePublished - 2016

Bibliographical note

Publisher Copyright:
Copyright © 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.

Keywords

  • (DEN)
  • (WON)
  • (WOPN)
  • Direct endoscopic
  • Necrosectomy
  • Necrosectomy
  • Necrosis
  • Necrosis
  • Pancreatic
  • Pancreatitis
  • Pseudocyst
  • Walled-off
  • Walled-off

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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