Abstract
Background: Direct endoscopic necrosectomy (DEN) for treatment of walled-off pancreatic necrosis (WOPN) has been performed as an alternative to operative or percutaneous therapy. Objective: To report the largest combined experience of DEN performed for WOPN. Design: Retrospective chart review. Setting: Six U.S. tertiary medical centers. Patients A total of 104 patients with a history of acute pancreatitis and symptomatic WOPN since 2003. Interventions: DEN for WOPN. Main Outcome Measurements: Resolution or near-resolution of WOPN without the need for surgical or percutaneous intervention and procedural complications. Results Successful resolution was achieved in 95 of 104 patients (91%). Of the patients in whom it failed, 5 died during follow-up before resolution, 2 underwent operative drainage for persistent WOPN, 1 required surgery for massive bleeding on fistula tract dilation, and 1 died periprocedurally. The mean time to resolution from the initial DEN was 4.1 months. The first dbridement was performed a mean of 63 days after the initial onset of acute pancreatitis. In 73%, the entry was transgastric with median tract dilation diameter of 18 mm. The median number of procedures was 3 with 2 dbridements. Complications occurred in approximately 14% and included 5 retrogastric perforations/pneumoperitoneum, which were managed nonoperatively. Univariate analysis identified a body mass index >32 as a risk factor for failed DEN. Limitation:s Retrospective, highly specialized centers. Conclusions: This large, multicenter series demonstrates that transmural, minimally invasive endoscopic dbridement of WOPN performed in the United States is an efficacious and reproducible technique with an acceptable safety profile.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 718-726 |
| Number of pages | 9 |
| Journal | Gastrointestinal endoscopy |
| Volume | 73 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2011 |
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Keywords
- BMI
- DEN
- WOPN
- body mass index
- direct endoscopic necrosectomy
- walled-off pancreatic necrosis
Cite this
Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis : Results from a multicenter U.S. series. / Gardner, Timothy B.; Coelho-Prabhu, Nayantara; Gordon, Stuart R.; Gelrud, Andres; Maple, John T.; Papachristou, Georgios I.; Freeman, Martin L.; Topazian, Mark D.; Attam, Rajeev; MacKenzie, Todd A.; Baron, Todd H.
In: Gastrointestinal endoscopy, Vol. 73, No. 4, 01.04.2011, p. 718-726.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis
T2 - Results from a multicenter U.S. series
AU - Gardner, Timothy B.
AU - Coelho-Prabhu, Nayantara
AU - Gordon, Stuart R.
AU - Gelrud, Andres
AU - Maple, John T.
AU - Papachristou, Georgios I.
AU - Freeman, Martin L.
AU - Topazian, Mark D.
AU - Attam, Rajeev
AU - MacKenzie, Todd A.
AU - Baron, Todd H.
PY - 2011/4/1
Y1 - 2011/4/1
N2 - Background: Direct endoscopic necrosectomy (DEN) for treatment of walled-off pancreatic necrosis (WOPN) has been performed as an alternative to operative or percutaneous therapy. Objective: To report the largest combined experience of DEN performed for WOPN. Design: Retrospective chart review. Setting: Six U.S. tertiary medical centers. Patients A total of 104 patients with a history of acute pancreatitis and symptomatic WOPN since 2003. Interventions: DEN for WOPN. Main Outcome Measurements: Resolution or near-resolution of WOPN without the need for surgical or percutaneous intervention and procedural complications. Results Successful resolution was achieved in 95 of 104 patients (91%). Of the patients in whom it failed, 5 died during follow-up before resolution, 2 underwent operative drainage for persistent WOPN, 1 required surgery for massive bleeding on fistula tract dilation, and 1 died periprocedurally. The mean time to resolution from the initial DEN was 4.1 months. The first dbridement was performed a mean of 63 days after the initial onset of acute pancreatitis. In 73%, the entry was transgastric with median tract dilation diameter of 18 mm. The median number of procedures was 3 with 2 dbridements. Complications occurred in approximately 14% and included 5 retrogastric perforations/pneumoperitoneum, which were managed nonoperatively. Univariate analysis identified a body mass index >32 as a risk factor for failed DEN. Limitation:s Retrospective, highly specialized centers. Conclusions: This large, multicenter series demonstrates that transmural, minimally invasive endoscopic dbridement of WOPN performed in the United States is an efficacious and reproducible technique with an acceptable safety profile.
AB - Background: Direct endoscopic necrosectomy (DEN) for treatment of walled-off pancreatic necrosis (WOPN) has been performed as an alternative to operative or percutaneous therapy. Objective: To report the largest combined experience of DEN performed for WOPN. Design: Retrospective chart review. Setting: Six U.S. tertiary medical centers. Patients A total of 104 patients with a history of acute pancreatitis and symptomatic WOPN since 2003. Interventions: DEN for WOPN. Main Outcome Measurements: Resolution or near-resolution of WOPN without the need for surgical or percutaneous intervention and procedural complications. Results Successful resolution was achieved in 95 of 104 patients (91%). Of the patients in whom it failed, 5 died during follow-up before resolution, 2 underwent operative drainage for persistent WOPN, 1 required surgery for massive bleeding on fistula tract dilation, and 1 died periprocedurally. The mean time to resolution from the initial DEN was 4.1 months. The first dbridement was performed a mean of 63 days after the initial onset of acute pancreatitis. In 73%, the entry was transgastric with median tract dilation diameter of 18 mm. The median number of procedures was 3 with 2 dbridements. Complications occurred in approximately 14% and included 5 retrogastric perforations/pneumoperitoneum, which were managed nonoperatively. Univariate analysis identified a body mass index >32 as a risk factor for failed DEN. Limitation:s Retrospective, highly specialized centers. Conclusions: This large, multicenter series demonstrates that transmural, minimally invasive endoscopic dbridement of WOPN performed in the United States is an efficacious and reproducible technique with an acceptable safety profile.
KW - BMI
KW - DEN
KW - WOPN
KW - body mass index
KW - direct endoscopic necrosectomy
KW - walled-off pancreatic necrosis
UR - http://www.scopus.com/inward/record.url?scp=79953236436&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79953236436&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2010.10.053
DO - 10.1016/j.gie.2010.10.053
M3 - Article
C2 - 21237454
AN - SCOPUS:79953236436
VL - 73
SP - 718
EP - 726
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 4
ER -