Skip to main content
SpringerLink
Log in

Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic management of walled-off pancreatic necrosis (WOPN) is an area of great interest with many still unanswered questions, including the role of mechanical necrosectomy versus irrigation. The aim of this study was to evaluate a new method of endoscopic transmural necrosectomy.

Methods

Patients with WOPN after necrotizing pancreatitis, who underwent endoscopic transmural necrosectomy using a lumen-apposing metal stent with vigorous irrigation sessions, were prospectively recruited between September 2011 and August 2014. Initial endoscopic session was performed by EUS-guided drainage and lavage sessions by flushing saline through the stent. Technical and clinical success rates, number of repeat interventions, and adverse events were analyzed.

Results

Twelve patients with 13 WOPN collections (median size 12.4 ± 2.94 cm) underwent endoscopic treatment. Clinical success was achieved in 100 % of cases after a median of three sessions per patient (range 2–8). The median length of hospitalization was 15.9 days. Median procedure time of the access session was 31 ± 10.16 min. No adverse events (AE) were described during the procedures or 24 h after. There were four AE (two infections and two bleedings) between sessions, but only two were severe (16.6 %). There was no need for surgery, and no mortalities occurred. Mean time to stent retrieval was 9 ± 3.4 weeks. Mean follow-up was 13 months with only one recurrence at 12 months after stent removal.

Conclusions

This new variant of irrigation endoscopic transmural necrosectomy without mechanical debridement helps to simplify the technique, is feasible, and has excellent outcomes in WOPN treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS (2013) Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Jürgensen C, Neser F, Boese-Landgraf J, Schuppan D, Stölzel U, Fritscher-Ravens A (2012) Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary? Surg Endosc 26:1359–1363

    Article  PubMed  Google Scholar 

  4. Yasuda I, Nakashima M, Iwai T, Isayama H, Itoi T, Hisai H, Inoue H, Kato H, Kanno A, Kubota K, Irisawa A, Igarashi H, Okabe Y, Kitano M, Kawakami H, Hayashi T, Mukai T, Sata N, Kida M, Shimosegawa T (2013) Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: the JENIPaN study. Endoscopy 45:627–634

    Article  CAS  PubMed  Google Scholar 

  5. Smoczynski M, Marek I, Dubowik M, Rompa G, Kobiela J, Studniarek M, Pieńkowska J, Adrych K (2014) Endoscopic drainage/debridement of walled-off pancreatic necrosis—single center experience of 112 cases. Pancreatology 14:137–142

    Article  CAS  PubMed  Google Scholar 

  6. Trikudanathan G, Attam R, Arain MA, Mallery S, Freeman ML (2014) Endoscopic interventions for necrotizing pancreatitis. Am J Gastroenterol 109:969–981

    Article  PubMed  Google Scholar 

  7. Mouli VP, Sreenivas V, Garg PK (2013) Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis. Gastroenterology 144(333–340):e2

    PubMed  Google Scholar 

  8. Hritz I, Fejes R, Székely A, Székely I, Horváth L, Sárkány A, Altorjay A, Madácsy L (2013) Endoscopic transluminal pancreatic necrosectomy using a self-expanding metal stent and high-flow water-jet system. World J Gastroenterol 19:3685–3692

    Article  PubMed  PubMed Central  Google Scholar 

  9. Binmoeller KF (2013) EUS-guided drainage of pancreatic fluid collections using fully covered self-expandable metal stents. Gastroenterol Hepatol (NY) 9:442–444

    Google Scholar 

  10. Working Group IAP/APA acute pancreatitis guidelines (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13(4Suppl2):e1–e15

    Google Scholar 

  11. Bang JY, Varadarajulu S (2013) Metal versus plastic stent for transmural drainage of pancreatic fluid collections. Clin Endosc 46:500–502

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fabbri C, Luigiano C, Lisotti A, Cennamo V, Virgilio C, Caletti G, Fusaroli P (2014) Endoscopic ultrasound-guided treatments: are we getting evidence based—a systematic review. World J Gastroenterol 20:8424–8448

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chandran S, Efthymiou M, Kaffes A, Chen JW, Kwan V, Murray M, Williams D, Nguyen NQ, Tam W, Welch C, Chong A, Gupta S, Devereaux B, Tagkalidis P, Parker F, Vaughan R (2015) Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos). Gastrointest Endosc 81:127–135

    Article  PubMed  Google Scholar 

  14. Saxena P, Singh VK, Messallam A, Kamal A, Zaheer A, Kumbhari V, Lennon AM, Canto MI, Kalloo AN, Baron TH, Khashab MA (2014) Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video). Gastrointest Endosc 80:319–324

    Article  PubMed  Google Scholar 

  15. Itoi T, Binmoeller KF, Shah J, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N, Moriyasu F (2012) Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 75:870–876

    Article  PubMed  Google Scholar 

  16. Gornals JB, De la Serna-Higuera C, Sánchez-Yague A, Loras C, Sánchez-Cantos AM, Pérez-Miranda M (2013) Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg Endosc 27:1428–1434

    Article  PubMed  Google Scholar 

  17. Busquets J, Peláez N, Secanella L, Darriba M, Bravo A, Santafosta E, Valls C, Gornals J, Peña C, Fabregat J (2014) Evolution and results of the surgical management of 143 cases of severe acute pancreatitis in a referral centre. Cir Esp 92:595–603

    Article  PubMed  Google Scholar 

  18. 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

    Article  CAS  PubMed  Google Scholar 

  19. Gardner TB, Coelho-Prabhu N, Gordon SR, Gelrud A, Maple JT, Papachristou G, Freeman ML, Topazian MD, Attam R, Mackenzie T, Baron TH (2011) Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S.series. Gastrointes Endosc 73:718–726

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Dr. C Loras, Hospital Universitari Mutua de Terrassa, for critical reading of the manuscript.

Author information

Authors and Affiliations

  1. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain

    Joan B. Gornals, Claudia F. Consiglieri, Silvia Salord & Meritxell de-la-Hera

  2. Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain

    Juli Busquets, Lluis Secanella, Nuria Pelaez & Joan Fabregat

  3. Department of Anesthesiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain

    Susana Redondo

Authors
  1. Joan B. Gornals
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudia F. Consiglieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juli Busquets
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Silvia Salord
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Meritxell de-la-Hera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lluis Secanella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Susana Redondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nuria Pelaez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joan Fabregat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joan B. Gornals.

Ethics declarations

Disclosures

Drs. Joan B Gornals, Claudia F Consiglieri, Juli Busquets MD, Silvia Salord, Meritxell de-la-Hera, Lluis Secanella, Susana Redondo, Nuria Pelaez, and Joan Fabregat have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video: Endoscopic ultrasound-guided necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent, with a cautery-tipped stent delivery system, and irrigation technique (non-mechanical). A double pigtail plastic stent is placed through the AXIOS stent (patient #12) (WMV 21085 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gornals, J.B., Consiglieri, C.F., Busquets, J. et al. Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique. Surg Endosc 30, 2592–2602 (2016). https://doi.org/10.1007/s00464-015-4505-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4505-2

Keywords

Search

Navigation