Abstract
Aim
To review the current status of the novel technique of endoscopic necrosectomy in the management of pancreatic necrosis after acute pancreatitis.
Methods
Studies were identified by searching Medline, PubMed and Embase databases for articles from January 1990 to December 2009 using the keywords “acute pancreatitis”, “pancreatic necrosis” and “endoscopy”. Additional papers were identified by a manual search of the references from the key articles. Case series of fewer than five patients and case reports were excluded.
Results
Indications, techniques and outcomes of endoscopic necrosectomy were analysed. There were no randomised controlled trials identified. Ten case series were included in this analysis. There were a total of more than 1,100 endoscopic necrosectomy procedures in 260 patients with pancreatic necrosis. One hundred fifty-five were proven to be infected necrosis on culture. The overall mortality rate was 5%. The mean procedure-related morbidity rate was 27%. The rate of complete resolution of pancreatic necrosis with the endoscopic method alone was 76%.
Conclusions
Endoscopic necrosectomy is a safe and effective treatment option in selected patients with pancreatic necrosis after acute pancreatitis. Future studies will be required to further define the selection criteria and the techniques for the endoscopic procedure.
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References
Banks PA, Freeman ML (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101(10):2379–2400
Beger HG, Buchler M, Bittner R et al (1988) Necrosectomy and postoperative local lavage in patients with necrotizing pancreatitis: results of a prospective clinical trial. World J Surg 12(2):255–262
Traverso LW, Kozarek RA (2005) Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg 9(3):436–439
Rodriguez JR, Razo AO, Targarona J et al (2008) Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg 247(2):294–299
Howard TJ, Patel JB, Zyromski N et al (2007) Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg 11(1):43–49
Rau B, Bothe A, Beger HG (2005) Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery 138(1):28–39
Connor S, Alexakis N, Raraty MG et al (2005) Early and late complications after pancreatic necrosectomy. Surgery 137(5):499–505
Ashley SW, Perez A, Pierce EA et al (2001) Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases. Ann Surg 234(4):572–579; discussion 579–580
Buchler MW, Gloor B, Muller CA et al (2000) Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 232(5):619–626
Tsiotos GG, Luque-de Leon E, Sarr MG (1998) Long-term outcome of necrotizing pancreatitis treated by necrosectomy. Br J Surg 85(12):1650–1653
Friedland S, Kaltenbach T, Sugimoto M et al (2009) Endoscopic necrosectomy of organized pancreatic necrosis: a currently practiced NOTES procedure. J Hepatobiliary Pancreat Surg 16(3):266–269
Bradley EL III, Dexter ND (2010) Management of severe acute pancreatitis: a surgical odyssey. Ann Surg 251(1):6–17
de Meijer VE, Kalish BT, Puder M et al (2010) Systematic review and meta-analysis of steatosis as a risk factor in major hepatic resection. Br J Surg 97(9):1331–1339
Seifert H, Biermer M, Schmitt W et al (2009) Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 58(9):1260–1266
Papachristou GI, Takahashi N, Chahal P et al (2007) Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245(6):943–951
Phillips B, Ball C, Sacket D et al (2011) Oxford Centre for Evidence-Based Medicine Level of Evidence, Oxford
Gardner TB, Chahal P, Papachristou GI et al (2009) A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc 69(6):1085–1094
Schrover IM, Weusten BL, Besselink MG et al (2008) EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis. Pancreatology 8(3):271–276
Mathew A, Biswas A, Meitz KP (2008) Endoscopic necrosectomy as primary treatment for infected peripancreatic fluid collections (with video). Gastrointest Endosc 68(4):776–782
Escourrou J, Shehab H, Buscail L et al (2008) Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis. Ann Surg 248(6):1074–1080
Voermans RP, Veldkamp MC, Rauws EA et al (2007) Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc 66(5):909–916
Charnley RM, Lochan R, Gray H et al (2006) Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy 38(9):925–928
Seewald S, Groth S, Omar S et al (2005) Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc 62(1):92–100
Baron TH, Harewood GC, Morgan DE et al (2002) Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 56(1):7–17
McGee MF, Schomisch SJ, Marks JM et al (2008) Late phase TNF-alpha depression in natural orifice translumenal endoscopic surgery (NOTES) peritoneoscopy. Surgery 143(3):318–328
Freeman LJ, Rahmani EY, Al-Haddad M et al (2010) Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy. Gastrointest Endosc 72(2):373–380
Lemaire LC, van der Poll T, van Lanschot JJ et al (1998) Minimally invasive surgery induces endotoxin-tolerance in the absence of detectable endotoxemia. J Clin Immunol 18(6):414–420
van Santvoort HC, Besselink MG, Bakker OJ et al (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362(16):1491–1502
Kahaleh M, Shami VM, Conaway MR et al (2006) Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy 38(4):355–359
Tonsi AF, Bacchion M, Crippa S et al (2009) Acute pancreatitis at the beginning of the 21st century: the state of the art. World J Gastroenterol 15(24):2945–2959
Barthet M, Ezzedine S (2009) Transluminal endoscopic necrosectomy for pancreatic necrosis: in all hands and for all patients, or with selected endoscopists in selected patients? Gut 58(9):1180–1182
Blettner M, Sauerbrei W, Schlehofer B et al (1999) Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int J Epidemiol 28(1):1–9
Bravata DM, Olkin I (2001) Simple pooling versus combining in meta-analysis. Eval Health Prof 24(2):218–230
Disclosure
Authors Alireza Haghshenasskashani, Jerome M. Laurence, Vu Kwan, Emma Johnston, Michael J. Hollands, Arthur J. Richardson, Henry C. C. Pleass and Vincent W. T. Lam have no conflicts of interest or financial ties to disclose.
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Haghshenasskashani, A., Laurence, J.M., Kwan, V. et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc 25, 3724–3730 (2011). https://doi.org/10.1007/s00464-011-1795-x
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DOI: https://doi.org/10.1007/s00464-011-1795-x