2011 SSAT Plenary Presentation

Journal of Gastrointestinal Surgery

, Volume 16, Issue 2, pp 248-257

Dual Modality Drainage for Symptomatic Walled-Off Pancreatic Necrosis Reduces Length of Hospitalization, Radiological Procedures, and Number of Endoscopies Compared to Standard Percutaneous Drainage

  • Michael GluckAffiliated withThe Digestive Disease Institute, Virginia Mason Medical Center Email author 
  • , Andrew RossAffiliated withThe Digestive Disease Institute, Virginia Mason Medical Center
  • , Shayan IraniAffiliated withThe Digestive Disease Institute, Virginia Mason Medical Center
  • , Otto LinAffiliated withThe Digestive Disease Institute, Virginia Mason Medical Center
  • , S. Ian GanAffiliated withThe Digestive Disease Institute, Virginia Mason Medical Center
  • , Mehran FotoohiAffiliated withDepartment of Radiology, Virginia Mason Medical Center
  • , Ellen HauptmannAffiliated withDepartment of Radiology, Virginia Mason Medical Center
  • , Robert CraneAffiliated withDepartment of Radiology, Virginia Mason Medical Center
  • , Justin SiegalAffiliated withDepartment of Radiology, Virginia Mason Medical Center
    • , David H. RobinsonAffiliated withDepartment of Radiology, Virginia Mason Medical Center
    • , L. W. TraversoAffiliated withCenter for Pancreatic Disease, St. Luke’s Health System
    • , Richard A KozarekAffiliated withThe Digestive Disease Institute, Virginia Mason Medical Center

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Abstract

Background

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).

Aim

The aim of this study is to demonstrate that as the cohort of DMD and SPD patients expand, the original conclusions are durable.

Methods

The database of patients receiving treatment for WOPN between January 2006 and April 2011 was analyzed retrospectively.

Patients

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.

Results

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.

Conclusion

DMD for symptomatic WOPN reduces LOH, radiological procedures, and number of ERCPs compared to SPD.

Keywords

Walled-off pancreatic necrosis WOPN Dual modality drainage Standard percutaneous drainage