scholarly journals Endoscopic transgastric cholecystectomy during direct endoscopic necrosectomy for walled-off necrosis of the pancreas

Endoscopy ◽  
2021 ◽  
Author(s):  
Marcos Eduardo Lera dos Santos ◽  
Igor Braga Ribeiro ◽  
Igor Mendonça Proença ◽  
Gabriel Mayo Vieira de Souza ◽  
Diogo Turiani Hourneaux de Moura ◽  
...  
Keyword(s):  
Endoscopic Necrosectomy ◽  
Transgastric Cholecystectomy ◽  
Walled Off Necrosis

scholarly journals Direct endoscopic necrosectomy in infected pancreatic necrosis using lumen-apposing metal stents: Early intervention does not compromise outcome

2021 ◽  
Vol 09 (03) ◽  
pp. E490-E495
Author(s):  
David Albers ◽  
Alexander Meining ◽  
Alexander Hann ◽  
Younan Kabara Ayoub ◽  
Brigitte Schumacher
Keyword(s):  
Early Intervention ◽  
Pancreatic Necrosis ◽  
Early Stage ◽  
Clinical Success ◽  
Infected Pancreatic Necrosis ◽  
Metal Stents ◽  
Optimal Timing ◽  
Stent Insertion ◽  
Endoscopic Necrosectomy ◽  
Walled Off Necrosis

Abstract Background and study aims Infection of pancreatic necrosis is a dreaded complication requiring an intervention. Nevertheless, the optimal timing of the first intervention is unclear, and consensus data are sparse. This retrospective two-center study evaluated direct endoscopic necrosectomy using lumen apposing metal stents in case of proven or suspected infected pancreatic necrosis in an early stage of the disease. Patients and methods Forty-nine patients with infected pancreatic necrosis were included. Sequent direct endoscopic necrosectomies after lumen apposing metal stent insertion (LAMS) were performed until the resolution of necrosis. In all patients, the first endoscopic intervention was performed within the first 30 days after first proof of pancreatic necrosis. Primary outcome parameters were inflammatory activity, days spent in the Intensive Care Unit (ICU), and mortality. Results The patient cohort received median 4 necrosectomies (3–5) after a median of 7 days (3–11) after first proof of pancreatic necrosis. Technical and clinical success were achieved in 98.3 % and 87.8 %, respectively; the mortality rate was 8.2 %. The median C-reactive protein level decreased from 241 mg/L (182.9–288.9) before the intervention to a median of 23.3 mg/L (18–60) after therapy. The median time period in the ICU was 5 days (3–9). Conclusions Early endoscopic therapy in the form of direct endoscopic necrosectomy after LAMS placement within the first 30 days after proof of pancreatic necrosis is effective and does not result in poor outcome. Our retrospective data suggest that early intervention before walled-off necrosis is formed is tenable when it is essential due to the patient's clinical deterioration.

Drenaje guiado por ultrasonido endoscópico con stent metálico de aposición luminal y necrosectomía endoscópica directa para el tratamiento de la necrosis pancreática infectada

2020 ◽  
Vol 50 (2) ◽  
Keyword(s):  
Pancreatic Necrosis ◽  
Tube Feeding ◽  
Safe Procedure ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid ◽  
Nasojejunal Tube ◽  
Fluid Collections ◽  
Walled Off Necrosis ◽  
First Time

Walled-off necrosis (WON) is a serious complication of acute pancreatitis (AP) and, when is infected, has a poor prognosis and mortality rate (15%). The endoscopic approach is preferable to surgical treatment due to its lower morbidity. Objectives. 1) Present a patient with infected pancreatic necrosis resolved by Endoscopic Ultrasound (EUS) guided drainage with a luminal apposition metal stent (LAMS) and Direct Endoscopic Necrosectomy (DEN). 2) Report placement of the LAMS Hot Axios ® (Boston Scientific) for the first time ever in Argentina. Methods. Male, 38 years old, without relevant history. He is hospitalized for a severe acute biliary pancreatitis (AP), early satiety and digestive intolerance. At 4 weeks, CT scan shows a PFC of 16 cm. EUS-guided drainage was performed with LAMS Hot Axios ®, draining 1600 ml of brown liquid content. Ten days later, another episode of severe AP. Continuous fever. New CT and EUS, showed increased collection, in situ stent and necrosis inside (WON). Four sessions of DEN through-the-LAMS and laparoscopic cholecystectomy were performed. Percutaneous drainage of left pararenal necrosis. Nasojejunal tube feeding between each necrosectomy. At 8th week, absence of necrosis and granulation tissue was observed, then the LAMS was removed. Hospital discharge. After 6 months of follow up, CT control showed normal pancreatic parenchyma. Conclusions. EUS-guided drainage of Pancreatic fluid collections (PFC) with LAMS is a safe procedure. In cases of WON, LAMS also allows transluminal interventional procedures, expediting the treatment of pancreatic necrosis, in a minimally invasive way.

Endoscopic ultrasound-guided drainage of pancreatic walled-off necrosis using 20-mm versus 15-mm lumen-apposing metal stents: an international, multicenter, case-matched study

Endoscopy ◽  
2020 ◽  
Vol 52 (03) ◽  
pp. 211-219 ◽  
Author(s):  
Nasim Parsa ◽  
Jose M. Nieto ◽  
Patrick Powers ◽  
Shuji Mitsuhashi ◽  
Abdelhai Abdelqader ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Conditional Logistic Regression ◽  
Metal Stents ◽  
Bleeding Events ◽  
Retrospective Case ◽  
Endoscopic Necrosectomy ◽  
Matched Study ◽  
Walled Off Necrosis

Abstract Backgrounds Endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMSs) has gained popularity for the treatment of pancreatic walled-off necrosis (WON). We compared the 20-mm and 15-mm LAMSs for the treatment of symptomatic WON in terms of clinical success and adverse events. Methods We conducted a retrospective, case-matched study of 306 adults at 22 tertiary centers from 04/2014 to 10/2018. A total of 102 patients with symptomatic WON who underwent drainage with 20-mm LAMS (cases) and 204 patients who underwent drainage with 15-mm LAMS (controls) were matched by age, sex, and drainage approach. Conditional logistic regression analysis was performed to compare clinical success (resolution of WON on follow-up imaging without reintervention) and adverse events (according to American Society for Gastrointestinal Endoscopy criteria). Results Clinical success was achieved in 92.2 % of patients with 20-mm LAMS and 91.7 % of patients with 15-mm LAMS (odds ratio 0.92; P = 0.91). Patients with 20-mm LAMS underwent fewer direct endoscopic necrosectomy (DEN) sessions (mean 1.3 vs. 2.1; P < 0.001), despite having larger WON collections (transverse axis 118.2 vs. 101.9 mm, P = 0.003; anteroposterior axis 95.9 vs. 80.1 mm, P = 0.01). There was no difference in overall adverse events (21.6 % vs. 15.2 %; P = 0.72) and bleeding events (4.9 % vs. 3.4 %; P = 0.54) between the 20-mm and 15-mm LAMS groups, respectively. Conclusions The 20-mm LAMS showed comparable clinical success and safety profile to the 15-mm LAMS, with the need for fewer DEN sessions for WON resolution.

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