scholarly journals Novel Resection System for Direct Endoscopic Necrosectomy of Walled-Off Pancreas Necrosis: Have We Conquered the Final Frontier?

2021 ◽  
Vol 12 (04) ◽  
pp. 258-260
Author(s):  
Surinder Singh Rana ◽  
Rajesh Gupta
Keyword(s):  
Pancreatic Necrosis ◽  
Large Diameter ◽  
Blunt Dissection ◽  
Traditional Management ◽  
Endoscopic Necrosectomy ◽  
Pancreas Necrosis ◽  
Endoscopic Debridement

AbstractSurgical necrosectomy has been the traditional management for pancreatic necrosis and is done using blunt dissection. However, lack of dedicated endoscopic accessories has been a major limitation in direct endoscopic necrosectomy (DEN). Standard endoscopic accessories cannot effectively remove large necrotic material. Also, diameter of instrument channel of the endoscope limits the ability to use large-diameter graspers that can remove large chunks of necrotic material. In this news, we discuss a recent study that has evaluated a new powered endoscopic debridement system for DEN.

scholarly journals Early experience with cap-assisted endoscopic pancreatic necrosectomy: A technique to enhance safe tissue extraction and decrease interventions

2019 ◽  
Vol 07 (07) ◽  
pp. E912-E915
Author(s):  
Nishant Puri ◽  
Alexander Hallac ◽  
Wichit Srikureja
Keyword(s):  
Median Duration ◽  
Pancreatic Necrosis ◽  
Inclusion Criteria ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid ◽  
Fluid Collections ◽  
Endoscopic Debridement ◽  
Tomography Scan ◽  
Retrospective Database

Abstract Background and study aim Endoscopic treatment of walled-off pancreatic necrosis (WOPN) has been established as an alternative to operative intervention for well selected patients for many years. Patients and methods A retrospective database of patients who underwent cap-assisted endoscopic necrosectomy of symptomatic or infected WOPN using the assistance of a sterilized banding cap was constructed. All procedures were performed at a single center between January 2017 and June 2018. Results Eight patients met the inclusion criteria for this study. Contrast computed tomography scan was obtained between the initial percutaneous or trans-gastric access and initial necrosectomy. The WOPN had a median length of 9.5 cm (range 3.2 – 14) and width of 5.3 cm (range 2.8 – 11.6). Median duration of endoscopic debridement was 69 minutes (range 21 – 105). Four of six patients underwent a second debridement with a median duration of 95 minutes (range 16 – 108). No periprocedural adverse events occurred. Follow-up was at 6 months, and there were no additional endoscopic or percutaneous interventions for recurrent pancreatic fluid collections. Conclusion The technique of cap-assisted necrosectomy can allow for safe and efficient method of endoscopically treating WOPN.

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.

scholarly journals Surgical Management of Necrotizing Pancreatitis

2021 ◽  
Author(s):  
Dane Thompson ◽  
Siavash Bolourani ◽  
Matthew Giangola
Keyword(s):  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Standard Of Care ◽  
Nutrition Intervention ◽  
Morbid Condition ◽  
Endoscopic Necrosectomy ◽  
Transmural Drainage ◽  
Percutaneous Endoscopic Necrosectomy ◽  
Invasive Techniques ◽  
First Line Treatment

Pancreatic necrosis is a highly morbid condition. It is most commonly associated with severe, acute pancreatitis, but can also be caused by trauma or chronic pancreatitis. Once diagnosed, management of pancreatic necrosis begins with supportive care, with an emphasis on early, and preferably, enteral nutrition. Intervention for necrosis, sterile or infected, is dictated by patient symptoms and response to conservative management. When possible, intervention should be delayed to allow the necrotic collection to form a capsule. First-line treatment for necrosis is with percutaneous drainage or endoscopic, transmural drainage. These strategies can be effective as monotherapy, but the need for repeated interventions, or for progression to more invasive interventions, is not uncommon. Necrosectomy may be performed using a previously established drainage tract, as in percutaneous endoscopic necrosectomy (PEN), video-assisted retroperitoneal debridement (VARD), and direct endoscopic necrosectomy (DEN). Although outcomes for these minimally-invasive techniques are better than for traditional necrosectomy, both laparoscopic and open techniques remain important for patients with extensive disease that cannot otherwise be adequately treated. This is especially true when pancreatic necrosis is complicated by disconnected pancreatic duct syndrome (DPDS), where necrosectomy remains standard of care.

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.

Hydrogen peroxide assisted endoscopic necrosectomy for walled-off pancreatic necrosis: A systematic review and meta-analysis

Pancreatology ◽  
2021 ◽  
Author(s):  
Rajat Garg ◽  
Shradha Gupta ◽  
Amandeep Singh ◽  
Marian T. Simonson ◽  
Tarun Rustagi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Pancreatic Necrosis ◽  
Meta Analysis ◽  
Endoscopic Necrosectomy

scholarly journals Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series

2020 ◽  
Vol 08 (03) ◽  
pp. E274-E280 ◽  
Author(s):  
S. E. van der Wiel ◽  
A. May ◽  
J. W. Poley ◽  
M. J. A. L. Grubben ◽  
J. Wetzka ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
De Novo ◽  
Necrotizing Pancreatitis ◽  
Case Series ◽  
Complete Removal ◽  
Endoscopic Drainage ◽  
Necrotic Tissue ◽  
Technical Feasibility ◽  
Operator Experience ◽  
Endoscopic Necrosectomy

Abstract Background and study aims Endoscopic drainage of walled-off necrosis and subsequent endoscopic necrosectomy has been shown to be an effective step-up management strategy in patients with acute necrotizing pancreatitis. One of the limitations of this endoscopic approach however, is the lack of dedicated and effective instruments to remove necrotic tissue. We aimed to evaluate the technical feasibility, safety, and clinical outcome of the EndoRotor, a novel automated mechanical endoscopic tissue resection tool, in patients with necrotizing pancreatitis. Methods Patients with infected necrotizing pancreatitis in need of endoscopic necrosectomy after initial cystogastroscopy, were treated using the EndoRotor. Procedures were performed under conscious or propofol sedation by six experienced endoscopists. Technical feasibility, safety, and clinical outcomes were evaluated and scored. Operator experience was assessed by a short questionnaire. Results Twelve patients with a median age of 60.6 years, underwent a total of 27 procedures for removal of infected pancreatic necrosis using the EndoRotor. Of these, nine patients were treated de novo. Three patients had already undergone unsuccessful endoscopic necrosectomy procedures using conventional tools. The mean size of the walled-off cavities was 117.5 ± 51.9 mm. An average of two procedures (range 1 – 7) per patient was required to achieve complete removal of necrotic tissue with the EndoRotor. No procedure-related adverse events occurred. Endoscopists deemed the device to be easy to use and effective for safe and controlled removal of the necrosis. Conclusions Initial experience with the EndoRotor suggests that this device can safely, rapidly, and effectively remove necrotic tissue in patients with (infected) walled-off pancreatic necrosis.

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