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Safety and Efficacy of Early (<4 Weeks of Illness) Endoscopic Transmural Drainage of Post-acute Pancreatic Necrosis Predominantly Located in the Body of the Pancreas

Journal of Gastrointestinal Surgery volume 25, pages 2328–2335 (2021)Cite this article

Abstract

Background

Endoscopic transmural drainage is usually not performed for pancreatic necrotic collection (PNC) < 4 weeks after onset of acute necrotizing pancreatitis (ANP) because of lack of encapsulating wall and increased risk of complications.

Objective

Study safety and efficacy of early (<4 weeks) endoscopic transluminal drainage in patients with symptomatic PNC.

Methods

Retrospective analysis of data base of patients with PNC treated with endoscopic transmural drainage within 4 weeks of onset of ANP (early drainage) was done. The outcomes and complications were compared with patients with PNC who underwent delayed endoscopic drainage (≥4 weeks of onset of ANP).

Results

Thirty-four patients (26 males; mean age: 35.9 ± 8.6 years) underwent early and 136 patients (115 males; mean age: 37.9 ± 9.4 years) underwent delayed endoscopic drainage. The PNC was significantly larger (12.3 ± 2.1 cm vs 10.5 ± 2.7 cm, p <0.001) with increased solid component (47.7 ± 8.9% vs 28.3 ± 11.7%, p <0.001) in the early group. Clinical success was achieved in 94% patients in the early group and all patients in the delayed group. Direct endoscopic necrosectomy was performed more frequently in the early group (50% vs 7.4%; p<0.001). There was increased mortality (5.7% vs 0%), need for rescue surgical necrosectomy (5.7% vs 0%), and clinically significant bleeding (20% vs 1.5%, p<0.001) in the early group as compared to the delayed group.

Conclusion

Early endoscopic drainage of PNC is feasible and seems to be safe as well as effective but is associated with increased risk of complications as compared to delayed drainage.

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Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Surinder Singh Rana, Ravi Sharma & Lovneet Dhalaria

  2. Department of Biostatistics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Kamal Kishore

  3. Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Rajesh Gupta

Authors
  1. Surinder Singh Rana
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  2. Ravi Sharma
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  3. Kamal Kishore
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  4. Lovneet Dhalaria
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  5. Rajesh Gupta
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Contributions

Surinder Singh Rana: collection and interpretation of data, drafting of manuscript, design of study; Ravi Sharma: collection and interpretation of data; Kamal Kishore: interpretation and analysis of data; Lovneet Dhalaria: collection and interpretation of data; Rajesh Gupta: collection and interpretation of data

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Correspondence to Surinder Singh Rana.

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Rana, S.S., Sharma, R., Kishore, K. et al. Safety and Efficacy of Early (<4 Weeks of Illness) Endoscopic Transmural Drainage of Post-acute Pancreatic Necrosis Predominantly Located in the Body of the Pancreas. J Gastrointest Surg 25, 2328–2335 (2021). https://doi.org/10.1007/s11605-021-04945-y

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  • DOI: https://doi.org/10.1007/s11605-021-04945-y

Keywords

  • Endosonography
  • Pancreatic necrosis
  • Stent
  • Acute pancreatitis
  • Computed tomography