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Endoskopisches retroperitoneales Débridement – sinnvolle Interventionen?

Endoscopic retroperitoneal debridement – a reasonable intervention?

  • Schwerpunkt: Neue Techniken in der Endoskopie
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Bei infizierten Nekrosen als Folge einer akuten Pankreatitis sind therapeutische Interventionen indiziert. Das transgastrale/transduodenale endoskopische retroperitoneale Débridement ist eine im Vergleich zum offenen chirurgischen Vorgehen weniger traumatische Alternative. Unter sonographischer Steuerung werden ausreichend große Fenster der Magenhinterwand zum Retroperitoneum angelegt, über die auch ausgedehnte Nekrosen und putride Prozesse ausgeräumt und gespült werden können. Die ersten Ergebnisse deutscher Zentren sind ermutigend: Bei 150 Patienten aus 7 Zentren betrug die Letalität 8%. Das transgastrale Débridement sollte immer mit der transpapillären endoskopischen Rekonstruktion eines möglichst intakten Pankreasganges mit physiologischem Sekretfluss kombiniert werden. Es scheint erwiesen, dass das sog. endoskopische Operieren durch angemessen große Fenster der Magenwand auch bei komplexer Anatomie mit minimalem Gewebstrauma und ohne große eingriffsbezogene Komplikationen möglich ist.

Abstract

There is a general consensus that infected peripancreatic necrosis following acute pancreatitis requires interventional therapy. Endoscopic transgastric retroperitoneal debridement is a less traumatic alternative to open surgical procedures. Sufficiently wide fenestrations of the posterior gastric wall to the retroperitoneal space are created under endosonographic control. Using this access, even extended necrotic and putrid lesions can be cleaned and flushed. The first results are encouraging. In 150 patients treated in five German hospitals, the mortality rate was 8%. It must be emphasized that endoscopic retroperitoneal necrosectomy should always be combined with the transpapillary reconstruction of the pancreatic duct ensuring the physiological flow of pancreatic secretion. “Endoscopic surgery” by gaining access through adequately wide gastric wall fenestrations seems possible with minimal tissue trauma and few intervention-related complications.

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Authors and Affiliations

  1. Klinik für Gastroenterologie, Hepatologie, Diabetologie und Infektiologie, Klinikum Oldenburg, Dr.-Eden-Straße 10, 26133, Oldenburg, Deutschland

    H. Seifert

  2. Medizinische Klinik I, Krankenhaus Siloah und Krankenhaus Oststadt, Hannover, Deutschland

    T. Wehrmann

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  1. H. Seifert
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  2. T. Wehrmann
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Correspondence to H. Seifert.

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Seifert, H., Wehrmann, T. Endoskopisches retroperitoneales Débridement – sinnvolle Interventionen?. Gastroenterologe 2, 100–109 (2007). https://doi.org/10.1007/s11377-006-0072-3

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  • DOI: https://doi.org/10.1007/s11377-006-0072-3

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