Endoscopic drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis - a single-center experience

Mateusz Jagielski, Marian Smoczyński, Michał Studniarek, Krystian Adrych, Mateusz Jagielski, Marian Smoczyński, Michał Studniarek, Krystian Adrych

Abstract

Introduction: In last three decades we have been observing development of minimally invasive walled-off pancreatic necrosis (WOPN) treatment techniques. The choice of access to the necrosis and technique of treatment depends not only on the position and spread of necrosis, but in the first place on the experience of the medical center.

Aim: To assess the effectiveness and safety of combined endoscopic and percutaneous drainage of WOPN.

Material and methods: We performed a retrospective analysis of 64 consecutive patients with symptomatic WOPN, who underwent endoscopic treatment in our department between 2011 and 2013.

Results: Additional percutaneous drainage was executed during endoscopic treatment in 20/64 (31.25%) patients. Complications of treatment occurred in 4/20 (20%) patients. Complications of treatment occurred in 4/20 (20%) patients. All these complications were related to endoscopic treatment. No complications related to percutaneous drainage were noted. There were no deaths. Therapeutic success was achieved in all 20 patients. No patients required surgery. The average time of endoscopic drainage was 41.4 (11-173) days. The mean number of endoscopic procedures was 4.2 (2-12). The average time of percutaneous drainage was 11.3 (5-20) days. The medium time of follow-up was 54 (48-64) months. During the observation the recurrence of WOPN was noted in 2/20 (10%) patients. Long-term success of combined drainage was achieved in 18/20 (90%) patients.

Conclusions: In selected patients with symptomatic WOPN combined endoscopic and percutaneous drainage enables a high success rate with a low procedure-related complication rate.

Keywords: endoscopic drainage; pancreatic necrosis; percutaneous drainage.

Figures

Figure 1
Figure 1
Fluoroscopic image shows endoscopic transmural drainage combined with percutaneous drainage in a patient with pancreatic necrosis
Figure 2
Figure 2
Contrast-enhanced computed tomography done before interventional treatment (A, B). Extensive WOPN collection is clearly visible. Endoscopic drainage (C) combined with percutaneous drainage was performed in this patient. Complete regression of necrosis was confirmed by CECT after 21 days of percutaneous drainage (D). Percutaneous catheter inserted retroperitoneally is visible on CT scan (D)
Figure 3
Figure 3
Image shows the patients with two percutaneous catheters guided transperitoneally into the area of WOPN

References

    1. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.
    1. Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262:751–64.
    1. Sarathi Patra P, Das K, Bhattacharyya A, et al. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg. 2014;101:1721–8.
    1. Manrai M, Kochhar R, Gupta V, et al. Outcome of acute pancreatic and peripancreatic collections occurring in patients with acute pancreatitis. Ann Surg. 2016 Epub ahead of print.
    1. Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41:1176–94.
    1. Besselink M, van Santvoort H, Freeman M, et al. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1–15.
    1. Gurusamy KS, Belgaumkar AP, Haswell A, et al. Interventions for necrotising pancreatitis. Cochrane Database Syst Rev. 2016;4 CD011383.
    1. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. New Engl J of Med. 2010;362:1491–502.
    1. Loveday BP, Petrov MS, Connor S, et al. A comprehensive classification of invasive procedures for treating the local complications of acute pancreatitis based on visualization, route, and purpose. Pancreatology. 2011;11:406–13.
    1. Bello B, Matthews JB. Minimally invasive treatment of pancreatic necrosis. World J Gastroenterol. 2012;18:6829–35.
    1. Freeny PC, Hauptmann E, Althaus SJ, et al. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol. 1998;170:969–75.
    1. Baron TH, Thaggard WG, Morgan DE, Stanley RJ. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology. 1996;111:755–64.
    1. Papachristou GI, Takahashi N, Chahal, et al. Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg. 2007;245:943–51.
    1. Ross A, Gluck M, Irani S, et al. Combined endoscopic and percutaneous drainage of organized pancreatic necrosis. Gastrointest Endosc. 2010;71:79–84.
    1. Gluck M, Ross A, Irani S, et al. Dual modality drainage for symptomatic walled-off pancreatic necrosis reduces length of hospitalization, radiological procedures, and number of endoscopies compared to standard percutaneous drainage. J Gastrointest Surg. 2012;16:248–57.
    1. 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;79:929–35.
    1. Smoczyński M, Marek I, Dubowik M, et al. Endoscopic drainage/debridement of walled-off pancreatic necrosis – single center experience of 112 cases. Pancreatology. 2014;14:137–42.
    1. Jagielski M, Smoczyński M, Jabłońska A, et al. The role of endoscopic ultrasonography in endoscopic debridement of walled-off pancreatic necrosis – a single center experience. Pancreatology. 2015;15:503–7.
    1. van Baal MC, van Santvoort HC, Bollen TL, et al. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg. 2011;98:18–27.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever