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Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary?

Surgical Endoscopy volume 26, pages 1359–1363 (2012)Cite this article

Abstract

Background

Findings have shown endoscopic necrosectomy to be beneficial for patients with symptomatic pancreatic necrosis accessible for an endoscopic approach. The available studies show that endoscopic necrosectomy requires a multitude of subsequent procedures including repeat irrigation for removal of the necrotic material. This study aimed to investigate the need for additional irrigation in patients with necrotizing pancreatitis treated by endoscopic necrosectomy.

Methods

The study enrolled 35 consecutive patients (27 men) with a median age of 59 years who had pancreatic necrosis treated with endoscopic necrosectomy. Endoscopic ultrasound–guided internal drainage and consecutive endoscopic necrosectomy was combined with interval multistenting of the cavity. Neither endoscopic nor external irrigation was part of the procedure.

Results

An average of 6.2 endoscopy sessions per patient were needed for access, necrosectomy, and stent management. The in-hospital mortality rate was 6% (2/35), including one procedure-related death resulting from postinterventional aspiration. The immediate morbidity rate was 9% (3/35). It was possible to achieve clinical remission for all the surviving patients with no additional surgery needed for management of the necroses. The median follow-up period was 23 months.

Conclusion

Neither endoscopic nor external flushing is needed for successful endoscopic treatment of symptomatic necroses. Even without irrigation, the outcome for patients treated with endoscopic necrosectomy is comparable to that described in the published data.

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References

  1. 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 138:28–39

    PubMed  Article  CAS  Google Scholar 

  2. Connor S, Alexakis N, Raraty MG, Ghaneh P, Evans J, Hughes M, Garvey CJ, Sutton R, Neoptolemos JP (2005) Early and late complications after pancreatic necrosectomy. Surgery 137:499–505

    PubMed  Article  CAS  Google Scholar 

  3. Besselink MG, de Bruijn MT, Rutten JP, Boermeester MA, Hofker HS, Gooszen HG, Dutch Acute Pancreatitis Study Group (2006) Surgical intervention in patients with necrotizing pancreatitis. Br J Surg 93:593–599

    PubMed  Article  CAS  Google Scholar 

  4. Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF (2000) Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 356:653–655

    PubMed  Article  CAS  Google Scholar 

  5. Charnley RM, Lochan R, Gray H, O’Sullivan CB, Scott J, Oppong KE (2006) Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy 38:925–928

    PubMed  Article  CAS  Google Scholar 

  6. Escourrou J, Shehab H, Buscail L, Bournet B, Andrau P, Moreau J, Fourtanier G (2008) Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis. Ann Surg 248:1074–1080

    PubMed  Article  Google Scholar 

  7. Gardner TB, Chahal P, Papachristou GI, Vege SS, Petersen BT, Gostout CJ, Topazian MD, Takahashi N, Sarr MG, Baron TH (2009) A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc 69:1085–1094

    PubMed  Article  Google Scholar 

  8. Hocke M, Will U, Gottschalk P, Settmacher U, Stallmach A (2008) Transgastral retroperitoneal endoscopy in septic patients with pancreatic necrosis or infected pancreatic pseudocysts. Z Gastroenterol 46:1363–1368

    PubMed  Article  CAS  Google Scholar 

  9. Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TH (2007) Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245:943–951

    PubMed  Article  Google Scholar 

  10. Schrover IM, Weusten BL, Besselink MG, Bollen TL, van Ramshorst B, Timmer R (2008) EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis. Pancreatology 8:271–276

    PubMed  Article  Google Scholar 

  11. Seewald S, Groth S, Omar S, Imazu H, Seitz U, de Weerth A, Soetikno R, Zhong Y, Sriram PV, Ponnudurai R, Sikka S, Thonke F, Soehendra N (2005) Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc 62:92–100

    PubMed  Article  Google Scholar 

  12. Voermans RP, Veldkamp MC, Rauws EA, Bruno MJ, Fockens P (2007) Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc 66:909–916

    PubMed  Article  Google Scholar 

  13. Coelho D, Ardengh JC, Eulálio JM, Manso JE, Mönkemüller K, Coelho JF (2008) Management of infected and sterile pancreatic necrosis by programmed endoscopic necrosectomy. Dig Dis 26:64–69

    Article  Google Scholar 

  14. Seifert H, Biermer M, Schmitt W, Jürgensen C, Will U, Gerlach R, Kreitmair C, Meining A, Wehrmann T, Rösch T (2009) Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 58:1260–1266

    PubMed  Article  CAS  Google Scholar 

  15. Baron TH, Thaggard WG, Morgan DE, Stanley RJ (1996) Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 111:755–764

    PubMed  Article  CAS  Google Scholar 

  16. Brückner M, Grimm H, Nam VC, Soehendra N (1990) Endoscopic treatment of a pancreatic abscess originating from biliary pancreatitis. Surg Endosc 4:227–229

    PubMed  Article  Google Scholar 

  17. Antillon MR, Bechtold ML, Bartalos CR, Marshall JB (2009) Transgastric endoscopic necrosectomy with temporary metallic esophageal stent placement for the treatment of infected pancreatic necrosis (with video). Gastrointest Endosc 69:178–180

    PubMed  Article  Google Scholar 

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Disclosures

Christian Jürgensen, Frank Neser, Joachim Boese-Landgraf, Detlef Schuppan, Ulrich Stölzel, and Annette Fritscher-Ravens have no conflicts of interest or financial ties to disclose.

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Affiliations

  1. Department of Gastroenterology, Rheumatology and Infectious Diseases, Charité University Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Christian Jürgensen

  2. Department of Medicine II, Klinikum Chemnitz, Chemnitz, Germany

    Frank Neser & Ulrich Stölzel

  3. Department of Surgery, Klinikum Chemnitz, Chemnitz, Germany

    Joachim Boese-Landgraf

  4. Department of Medicine I, University Mainz, Mainz, Germany

    Detlef Schuppan

  5. Department of Medicine I, University Hospital Kiel, Kiel, Germany

    Annette Fritscher-Ravens

Authors
  1. Christian Jürgensen
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  2. Frank Neser
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  3. Joachim Boese-Landgraf
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  4. Detlef Schuppan
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  5. Ulrich Stölzel
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  6. Annette Fritscher-Ravens
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Correspondence to Christian Jürgensen.

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Jürgensen, C., Neser, F., Boese-Landgraf, J. et al. Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary?. Surg Endosc 26, 1359–1363 (2012). https://doi.org/10.1007/s00464-011-2039-9

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  • DOI: https://doi.org/10.1007/s00464-011-2039-9

Keywords

  • Pancreatic
  • Therapeutic/palliation
  • Endoscopy
  • Ultrasonography