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Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis

Lookup NU author(s): Richard Charnley, Rajiv Lochan Jayadeva, Professor Kofi Oppong

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Abstract

Background and study aims: Open pancreatic necrosectomy is the standard treatment for infected pancreatic necrosis but is associated with significant morbidity, mortality, and prolonged hospital stay. Percutaneous or endoscopic necrosectomy are alternative techniques. We evaluated the use of endoscopic necrosectomy for treatment of patients with necrosis that could be accessed through the posterior wall of the stomach. Patients and methods: We retrospectively analyzed the indication, patient status according to acute physiology and chronic health evaluation (APACHE) 2 severity score, and success of endoscopic necrosectomy as primary treatment, in selected patients with localized infected pancreatic necrosis, who presented between May 2002 and October 2004. After the necrosis cavity had been accessed, with the assistance of endoscopic ultrasound, a large orifice was created and necrotic debris was removed using endoscopic accessories under radiological control. Followup was clinical and radiological. Results: 13 patients (nine men, four women, mean age 53 years), 11 with positive bacteriology, underwent attempted endoscopic necrosectomy. Median APACHE 2 score on presentation was 8 (range 1 - 18). Four patients needed intensive therapy unit care and one other patient required (nonventilatory) high-dependency unit care only. Necrosis was successfully treated endoscopically in 12 patients, requiring a mean of 4 endoscopic interventions (range 1 - 10); one patient required open surgery; two underwent additional percutaneous necrosectomy and one required laparoscopic drainage. Two patients died of complications unrelated to the procedure. The 11 survivors have a median (range) follow-up of 16 (6 - 38) months. Conclusion: Endoscopic necrosectomy is a safe method for treatment of infected pancreatic necrosis. Multiple procedures are usually needed. it may be combined with other methods of surgical intervention. Larger prospective studies will more precisely define its role.


Publication metadata

Author(s): Charnley RM, Lochan R, Gray H, O'Sullivan CB, Scott J, Oppong KENW

Publication type: Article

Publication status: Published

Journal: Endoscopy

Year: 2006

Volume: 38

Issue: 9

Pages: 925-928

ISSN (print): 0013-726X

ISSN (electronic): 1438-8812

Publisher: Georg Thieme Verlag

URL: http://dx.doi.org/10.1055/s-2006-944731

DOI: 10.1055/s-2006-944731


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