Dual Modality Drainage for Symptomatic Walled-Off Pancreatic Necrosis Reduces Length of Hospitalization, Radiological Procedures, and Number of Endoscopies Compared to Standard Percutaneous Drainage
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Symptomatic walled-off pancreatic necrosis (WOPN) treated with dual modality endoscopic and percutaneous drainage (DMD) has been shown to decrease length of hospitalization (LOH) and use of radiological resources in comparison to standard percutaneous drainage (SPD).
The aim of this study is to demonstrate that as the cohort of DMD and SPD patients expand, the original conclusions are durable.
The database of patients receiving treatment for WOPN between January 2006 and April 2011 was analyzed retrospectively.
One hundred two patients with symptomatic WOPN who had no previous drainage procedures were evaluated: 49 with DMD and 46 with SPD; 7 were excluded due to a salvage procedure.
Patient characteristics including age, sex, etiology of pancreatitis, and severity of disease based on computed tomographic severity index were indistinguishable between the two cohorts. The DMD cohort had shorter LOH, time until removal of percutaneous drains, fewer CT scans, drain studies, and endoscopic retrograde cholangiopancreatography (ERCPs; p < 0.05 for all). There were 12 identifiable complications during DMD, which were successfully treated without the need for surgery. The 30-day mortality in DMD was 4% (one multi-system organ failure and one out of the hospital with congestive heart failure). Three patients receiving SPD had surgery, and three (7%) died in the hospital.
DMD for symptomatic WOPN reduces LOH, radiological procedures, and number of ERCPs compared to SPD.
- Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice Guidelines in Acute Pancreatitis. Am J Gastroenterol 2006; 101:2379–2400. CrossRef
- Whitcomb DC. Acute Pancreatitis. New Engl J Med 2006; 354;2142–2150. CrossRef
- Baron TH, Morgan De. Acute necrotizing pancreatitis. New Engl J Med 1999; 340:1412–1418. CrossRef
- AGA Institute. Technical review on acute pancreatitis. Gastroenterology 2007;132:2022–2044. CrossRef
- Ashley SW, Perez A, Pierce EA, Brooks DC, Moore FD, Jr., Whang EE, Banks PA, Zinner MJ. Necrotizing pancreatitis. Contemporary analysis of 99 consecutive cases. Ann Surg 2001;234:572–580. CrossRef
- 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. CrossRef
- Howard TJ, Patel JB, Zyromski N, Sandrasegaran K, Yu J, Nakeeb A, Pitt HA, Lillemoe DK. Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg 2007; 11:43–49. CrossRef
- Van Santvoort HC, Besselink MG, Baker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Lameris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG, Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362:1491–502. CrossRef
- Parekh D. Laparoscopic-assisted pancreatic necrosectomy: a new surgical option for treatment of severe necrotizing pancreatitis. Arc Surg 2006; 141-895-903. CrossRef
- 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. CrossRef
- Ammori BJ. Laparoscopic transgastric pancreatic necrosectomy for infected pancreatic necrosis. Surg Endosc 2002; 16:1362. CrossRef
- Connor S, Ghaneh P, Raraty M, Sutton R, Rosso E, Garvey CJ, Hughes ML, Evans JC, Rowlands P, Neoptolemos JP. Minimally invasive retroperitoneal pancreatic necrosectomy. Dig Surg 2003; 20:270–277. CrossRef
- Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, Bulger E, Sinanan M, Langdale L, Kolokythas O, Andrews RT. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections. A multi-center, prospective, single-arm phase 2 study. Arch Surg 2010;145:817–825. CrossRef
- Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 1998; 170;969–975.
- Fotoohi M, Traverso LW. Management of severe pancreatic necrosis. Curr Treat Options Gastroenterol 2007; 10:341–346. CrossRef
- Fotoohi M, Traverso LW. Pancreatic necrosis: paradigm of a multidisciplinary team. Adv Surg 2006; 40:107–118. CrossRef
- Endlicher E, Volk M, Feuerbach S, Scholmerich J, Schuffler A, Messmann H. Long-term follow-up of patients with necrotizing pancreatitis treated by percutaneous necrosectomy. Hepato-Gastroenterol 2003; 50:2225–2228.
- VanSonnenberg E, Wittich GR, Chon KS, D’Agostino HB, Casola G, Easter D, Morgan RG, Walser EM, Nealon WH, Goodacre B, Stabile BE. Percutaneous radiologic drainage of pancreatic abscesses. AJR 1997; 168:979–984.
- Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TD. Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 2007; 245:843–951. CrossRef
- Gardner TB, Chahal P, Papachristou GI, Vege SS, Petersen BT, Gostout CJ, Topazian MD, Takahashi N, Sarr MG, Baron TH. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc 2009; 69:1085–1094. CrossRef
- Gardner TB, Coelho-Prabhu N, Gordon Sr, Gelrud A, Maple JT, Papachristou GI, Freeman ML, Topazian MD, Attam R, Mackenzie TA, Baron TH. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis; results from a multicenter U.S. series. Gastrointest Endosc 2011; 73:718–726. CrossRef
- Seifert H, Biermer M, Schmitt W, Jurgensen C, Will U, Gerlach R, Kreitmair C, Meining A, Wehrmann T, Rosch T. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009; 58:1260–1266. CrossRef
- Morgan DE, Ragheb CM, Lockhart ME, Cary B, Fineberg NS, Berland LL. Acute pancreatitis: computed tomography utilization and radiation exposure are related to severity but not patient age. Clin Gastroenterol Hepatol 2010; 8:303–308. CrossRef
- Fagenholz PJ, Fernandez-del Castillo C, Harris NS, Pelletier AJ, Camargo CA, Jr. Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas 2007; 35:302–307. CrossRef
- Shaheen NJ, Hansen RA, Morgan DR, Gangarosa LM, Ringel Y, Thiny MT, Russo MW, Sandler RS. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 2006; 101:2128–2138. CrossRef
- Ross A, Gluck M, Irani S, Hauptmann E, Fotoohi M, Siegal J, Robinson D, Crane R, Kozarek R. Combined endoscopic and percutaneous drainage of organized pancreatic necrosis. Gastrointest Endosc 2009; 71:79–84. CrossRef
- Gluck M, Ross A, Irani S, Lin O, Hauptmann E, Siegal J, Fotoohi M, Crane R, Robinson D, Kozarek RA. Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol 2010; 8:1083–1088. CrossRef
- Balthazar EJ, Freeny PC, VanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994; 193:297–306.
- Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 2002; 223:603–613. CrossRef
- Beger HG, Buchler M, Bittner R, Oettinger W, Block S, Nevalainen T. Necrosectomy and postoperative local lavage in patients with necrotizing pancreatitis: results of a prospective clinical trial. World J Surg 1988; 12:255–262. CrossRef
- Traverso L W, Kozarek RA. Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg 2005; 9:435–439. CrossRef
- Fernandez-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg 1998; 228:676–684. CrossRef
- Connor S, Raraty MGT, Neoptolemos JP, Layer P, Runzi M. Does infected pancreatic necrosis require immediate of emergency debridement? Pancreas 2006; 33:128–134. CrossRef
- Fotoohi M, D’Agostino HB, Wollman B, Chon K, Shahrokni S, VanSonnenberg E. Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: role of cause and severity of pancreatitis. Radiology 1999; 213:373–578.
- Mier J, Luque-de Leon E, Castillo A, Robledo F, Blanco R. Early versus late necrosectomy in severe necrotizing pancreatitis. Am j Surg 1997; 173:71–75. CrossRef
- Besselink MGH, Verwer TJ, Schoenmaeckers EJP, Buskens E, Ridwan BU, Visser MR, Nieuwenhuijs VB, Gooszen HG. Timing of surgical intervention of necrotizing pancreatitis. Arch Surg 2007; 142:1194–1201. CrossRef
- Dual Modality Drainage for Symptomatic Walled-Off Pancreatic Necrosis Reduces Length of Hospitalization, Radiological Procedures, and Number of Endoscopies Compared to Standard Percutaneous Drainage
Journal of Gastrointestinal Surgery
Volume 16, Issue 2 , pp 248-257
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Walled-off pancreatic necrosis
- Dual modality drainage
- Standard percutaneous drainage
- Industry Sectors
- Author Affiliations
- 1. The Digestive Disease Institute, Virginia Mason Medical Center, 1100 9th Ave., C3-GAS, Seattle, WA, 98101, USA
- 2. Department of Radiology, Virginia Mason Medical Center, Seattle, WA, USA
- 3. Center for Pancreatic Disease, St. Luke’s Health System, Boise, ID, USA