Surgical Endoscopy

, Volume 25, Issue 12, pp 3724–3730 | Cite as

Endoscopic necrosectomy of pancreatic necrosis: a systematic review

  • Alireza Haghshenasskashani
  • Jerome M. Laurence
  • Vu Kwan
  • Emma Johnston
  • Michael J. Hollands
  • Arthur J. Richardson
  • Henry C. C. Pleass
  • Vincent W. T. Lam



To review the current status of the novel technique of endoscopic necrosectomy in the management of pancreatic necrosis after acute pancreatitis.


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.


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%.


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.


Abdominal Pancreatic G-I < Endoscopy Intensive care General < Technical Clinical papers/trials/research 



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.


  1. 1.
    Banks PA, Freeman ML (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101(10):2379–2400PubMedCrossRefGoogle Scholar
  2. 2.
    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):255–262PubMedCrossRefGoogle Scholar
  3. 3.
    Traverso LW, Kozarek RA (2005) Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg 9(3):436–439PubMedCrossRefGoogle Scholar
  4. 4.
    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):294–299PubMedCrossRefGoogle Scholar
  5. 5.
    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):43–49PubMedCrossRefGoogle Scholar
  6. 6.
    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):28–39PubMedCrossRefGoogle Scholar
  7. 7.
    Connor S, Alexakis N, Raraty MG et al (2005) Early and late complications after pancreatic necrosectomy. Surgery 137(5):499–505PubMedCrossRefGoogle Scholar
  8. 8.
    Ashley SW, Perez A, Pierce EA et al (2001) Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases. Ann Surg 234(4):572–579; discussion 579–580PubMedCrossRefGoogle Scholar
  9. 9.
    Buchler MW, Gloor B, Muller CA et al (2000) Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 232(5):619–626PubMedCrossRefGoogle Scholar
  10. 10.
    Tsiotos GG, Luque-de Leon E, Sarr MG (1998) Long-term outcome of necrotizing pancreatitis treated by necrosectomy. Br J Surg 85(12):1650–1653PubMedCrossRefGoogle Scholar
  11. 11.
    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):266–269PubMedCrossRefGoogle Scholar
  12. 12.
    Bradley EL III, Dexter ND (2010) Management of severe acute pancreatitis: a surgical odyssey. Ann Surg 251(1):6–17PubMedCrossRefGoogle Scholar
  13. 13.
    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):1331–1339PubMedCrossRefGoogle Scholar
  14. 14.
    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):1260–1266PubMedCrossRefGoogle Scholar
  15. 15.
    Papachristou GI, Takahashi N, Chahal P et al (2007) Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245(6):943–951PubMedCrossRefGoogle Scholar
  16. 16.
    Phillips B, Ball C, Sacket D et al (2011) Oxford Centre for Evidence-Based Medicine Level of Evidence, OxfordGoogle Scholar
  17. 17.
    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):1085–1094PubMedCrossRefGoogle Scholar
  18. 18.
    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):271–276PubMedCrossRefGoogle Scholar
  19. 19.
    Mathew A, Biswas A, Meitz KP (2008) Endoscopic necrosectomy as primary treatment for infected peripancreatic fluid collections (with video). Gastrointest Endosc 68(4):776–782PubMedCrossRefGoogle Scholar
  20. 20.
    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):1074–1080PubMedCrossRefGoogle Scholar
  21. 21.
    Voermans RP, Veldkamp MC, Rauws EA et al (2007) Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc 66(5):909–916PubMedCrossRefGoogle Scholar
  22. 22.
    Charnley RM, Lochan R, Gray H et al (2006) Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy 38(9):925–928PubMedCrossRefGoogle Scholar
  23. 23.
    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):92–100PubMedCrossRefGoogle Scholar
  24. 24.
    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):7–17PubMedCrossRefGoogle Scholar
  25. 25.
    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):318–328PubMedCrossRefGoogle Scholar
  26. 26.
    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):373–380PubMedCrossRefGoogle Scholar
  27. 27.
    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):414–420PubMedCrossRefGoogle Scholar
  28. 28.
    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):1491–1502PubMedCrossRefGoogle Scholar
  29. 29.
    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):355–359PubMedCrossRefGoogle Scholar
  30. 30.
    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):2945–2959PubMedCrossRefGoogle Scholar
  31. 31.
    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):1180–1182PubMedCrossRefGoogle Scholar
  32. 32.
    Blettner M, Sauerbrei W, Schlehofer B et al (1999) Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int J Epidemiol 28(1):1–9PubMedCrossRefGoogle Scholar
  33. 33.
    Bravata DM, Olkin I (2001) Simple pooling versus combining in meta-analysis. Eval Health Prof 24(2):218–230PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alireza Haghshenasskashani
    • 1
  • Jerome M. Laurence
    • 1
    • 3
  • Vu Kwan
    • 2
  • Emma Johnston
    • 1
  • Michael J. Hollands
    • 1
  • Arthur J. Richardson
    • 1
  • Henry C. C. Pleass
    • 1
    • 3
  • Vincent W. T. Lam
    • 1
    • 3
  1. 1.Department of SurgeryWestmead HospitalWentworthville, SydneyAustralia
  2. 2.Department of Gastroenterology and HepatologyWestmead HospitalSydneyAustralia
  3. 3.Discipline of SurgeryUniversity of SydneySydneyAustralia

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