RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-107802
Percutaneous debridement and washout of walled-off abdominal abscess and necrosis using flexible endoscopy: a large single-center experience
Publikationsverlauf
Publikationsdatum:
27. November 2015 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201601/lookinside/thumbnails/309_10-1055-s-0041-107802-1.jpg)
Background and study aims: Direct percutaneous endoscopic necrosectomy has been described as a minimally invasive intervention for the debridement of walled-off pancreatic necrosis (WOPN). In this retrospective cohort study, we aimed to confirm these findings in a US referral center and evaluate the clinical value of this modality in the treatment of pancreatic necrosis as well as other types of intra-abdominal fluid collections and necrosis.
Patients and methods: Twelve consecutive patients with WOPN or other abdominal abscess requiring debridement and washout underwent computed tomography (CT)-guided drainage catheter placement. Each patient then underwent direct percutaneous endoscopic necrosectomy and washout with repeat debridement performed until complete. Drains were then removed once output fell below 30 mL/day and imaging confirmed resolution. The primary endpoints were time to clinical resolution and sustained resolution at 1-year follow up.
Results: Ten patients were treated for WOPN, one for necrotic hepatic abscesses, and one for omental necrosis. The median time to intervention was 85 days with an average of 2.3 necrosectomies performed. Complete removal of drains was accomplished in 11 patients (92 %). The median time to resolution was 57 days. No serious adverse events occurred; however, one patient developed pancreaticocutaneous fistulas. Ten patients completed 1-year surveillance of which none required drain replacement. No patients required surgery or repeat endoscopy.
Conclusions: This series supports the premise that direct percutaneous endoscopic necrosectomy is a safe and effective intervention for intra-abdominal fluid collections and necrosis in appropriately selected patients. Our study demonstrates a high clinical success rate with minimal adverse events. This modality offers several potential advantages over surgical and transgastric approaches including use of improved accessibility, an excellent safety profile, and requirement for only deep or moderate sedation.
-
References
- 1 Wu BU, Johannes RS, Sun X et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 2008; 57: 1698-1703
- 2 Besselink MG, van Santvoort HC, Boermeester MA et al. Timing and impact of infections in acute pancreatitis. Br J Surg 2009; 96: 267-273
- 3 Haghshenasskashani A, Laurence JM, Kwan V et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc 2011; 25: 3724-3730
- 4 Gooszen HG, Besselink MG, van Santvoort HC et al. Surgical treatment of acute pancreatitis. Langenbeck's archives of surgery/Deutsche Gesellschaft fur Chirurgie 2013; 398: 799-806
- 5 Bradley 3rd EL, Howard TJ, van Sonnenberg E et al. Intervention in necrotizing pancreatitis: an evidence-based review of surgical and percutaneous alternatives. J Gastrointest Surg 2008; 12: 634-639
- 6 Rau B, Bothe A, Beger HG. Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery 2005; 138: 28-39 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
- 7 Kumar N, Conwell DL, Thompson CC. Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization. Pancreas 2014; 43: 1334-1339
- 8 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
- 9 Gardner TB, Coelho-Prabhu N, Gordon SR et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc 2011; 73: 718-726
- 10 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
- 11 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). Gastrointes Endosc 2015; 81(2): 351-359
- 12 Mui LM, Wong SK, Ng EK et al. Combined sinus tract endoscopy and endoscopic retrograde cholangiopancreatography in management of pancreatic necrosis and abscess. Surg Endosc 2005; 19: 393-397
- 13 Cerecedo-Rodriguez J, Hernandez-Trejo A, Alanis-Monroy E et al. Endoscopic percutaneous pancreatic necrosectomy. Gastrointest Endosc 2014; 80: 165-166
- 14 Inoue T, Ichikawa H, Okumura F et al. Local administration of amphotericin B and percutaneous endoscopic necrosectomy for refractory fungal-infected walled-off necrosis: a case report and literature review. Medicine (Baltimore) 2015; 94: e558
- 15 Kumbhari V, Storm AC, Tieu AH et al. Percutaneous flexible endoscopic necrosectomy for a retroperitoneal abscess. Endoscopy 2014; (Suppl. 01) 46
- 16 Yamamoto N, Isayama H, Takahara N et al. Percutaneous direct-endoscopic necrosectomy for walled-off pancreatic necrosis. Endoscopy 2013; 45 Suppl 2