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Endoscopic ultrasound-guided transmural drainage of walled-off pancreatic necrosis in patients with portal hypertension and intra-abdominal collaterals

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Abstract

Background

Acute necrotizing pancreatitis (ANP) is complicated with segmental portal hypertension (PHT) and formation of venous collaterals. Presence of collaterals in vicinity of endoscopic transmural tract can lead to potentially catastrophic situation. Here, we report safety and outcome of EUS-guided transmural drainage of walled-off pancreatic necrosis (WOPN) in patients with PHT and intra-abdominal collaterals.

Methods

Retrospective analysis of collected database of patients (n=18; age 40.94±8.43 years; 17 males) who underwent EUS-guided transmural drainage of WOPN and had PHT with collaterals.

Results

Etiology of ANP: alcohol in 14 and gallstones in 3 patients. Mean size of collection was 10.7±3.5 cm, and all 18 patients had splenic vein thrombosis with 1 patient also having portal vein thrombosis. Drainage was not feasible in 1 patient as no window free of collaterals could be found. One patient with gastric variceal bleeding underwent drainage after successful obliteration of varix with glue. Multiple plastic stents were placed in 15 patients and fully covered self-expanding metallic stent (FCSEMS) in 1 patient and 1 patient required direct endoscopic necrosectomy (DEN). Mean procedures required were 3 ± 0.79 and time to resolution was 4.4 ± 1.3 weeks. One patient had post-drainage bleeding that was successfully managed with intravenous terlipressin and intermittent irrigation via nasocystic catheter. Successfully treated patients have been asymptomatic over follow up period of 15.65±12.2 weeks.

Conclusion

EUS-guided drainage of WOPN seems to be safe and effective in patients with portal hypertension and intra-abdominal collaterals.

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Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Surinder S Rana, Ravi Sharma & Sobur Uddin Ahmed

  2. Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Rajesh Gupta

Authors
  1. Surinder S Rana
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  2. Ravi Sharma
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  3. Sobur Uddin Ahmed
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  4. Rajesh Gupta
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Corresponding author

Correspondence to Surinder S Rana.

Ethics declarations

An informed consent was obtained from all the patients before the procedure and the protocol to retrospectively analyze the data was approved by the institute ethics committee.

Conflict of interest

SSR, RS, SUA, and RG declare that they have no conflict of interest.

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Rana, S.S., Sharma, R., Ahmed, S.U. et al. Endoscopic ultrasound-guided transmural drainage of walled-off pancreatic necrosis in patients with portal hypertension and intra-abdominal collaterals. Indian J Gastroenterol 36, 400–404 (2017). https://doi.org/10.1007/s12664-017-0792-y

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  • DOI: https://doi.org/10.1007/s12664-017-0792-y

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