Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis

Results from a multicenter U.S. series

Timothy B. Gardner, Nayantara Coelho-Prabhu, Stuart R. Gordon, Andres Gelrud, John T. Maple, Georgios I. Papachristou, Martin L. Freeman, Mark D. Topazian, Rajeev Attam, Todd A. MacKenzie, Todd H. Baron

Research output: Contribution to journalArticle

155 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)718-726
Number of pages9
JournalGastrointestinal Endoscopy
Volume73
Issue number4
DOIs
StatePublished - Apr 1 2011

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Necrosis
Pancreatitis
Therapeutics
Dilatation
Pneumoperitoneum
Fistula
Drainage
Body Mass Index
Hemorrhage
Safety

Keywords

  • BMI
  • DEN
  • WOPN
  • body mass index
  • direct endoscopic necrosectomy
  • walled-off pancreatic necrosis

Cite this

Gardner, T. B., Coelho-Prabhu, N., Gordon, S. R., Gelrud, A., Maple, J. T., Papachristou, G. I., ... Baron, T. H. (2011). Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: Results from a multicenter U.S. series. Gastrointestinal Endoscopy, 73(4), 718-726. https://doi.org/10.1016/j.gie.2010.10.053

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 journalArticle

Gardner, TB, Coelho-Prabhu, N, Gordon, SR, Gelrud, A, Maple, JT, Papachristou, GI, Freeman, ML, Topazian, MD, Attam, R, MacKenzie, TA & Baron, TH 2011, 'Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: Results from a multicenter U.S. series', Gastrointestinal Endoscopy, vol. 73, no. 4, pp. 718-726. https://doi.org/10.1016/j.gie.2010.10.053
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. / Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis : Results from a multicenter U.S. series. In: Gastrointestinal Endoscopy. 2011 ; Vol. 73, No. 4. pp. 718-726.
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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.",
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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.

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