scholarly journals Step-up approach for the management of pancreatic necrosis: a review of the literature

2019 ◽  
Vol 4 (1) ◽  
pp. e000308 ◽  
Author(s):  
Melanie Kay Sion ◽  
Kimberly A Davis
Keyword(s):  
Inflammatory Response ◽  
Treatment Strategy ◽  
Percutaneous Drainage ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Endoscopic Drainage ◽  
Review Of The Literature ◽  
Less Invasive ◽  
Video Assisted ◽  
Optimal Treatment Strategy

Infected necrotizing pancreatitis is a challenging condition to treat because of the profound inflammatory response these patients undergo which can then be exacerbated by interventions. Treatment of this condition has evolved in timing of intervention as well as method of intervention and includes less invasive options for treatment such as percutaneous drainage and endoscopic drainage, in addition to less invasive endoscopic and video-assisted or laparoscopic debridements. The precise optimal treatment strategy for these patients is an ongoing topic of discussion and may be different for each patient as this is a heterogenous condition.

scholarly journals Minimally invasive endoscopic treatment of necrotizing pancreatitis: A case report with images and review of the literature

2017 ◽  
Vol 63 (3) ◽  
pp. 207-209
Author(s):  
Cassia Lemos Moura ◽  
Priscila Pulita Azevedo Barros ◽  
Cristiane Mota Oliveira ◽  
Rogerio Colaiácovo ◽  
Juliana Marques Drigo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Severe Case ◽  
Treatment Modalities ◽  
Endoscopic Drainage ◽  
Review Of The Literature ◽  
Fluid Collections

Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.

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.

scholarly journals Various Endoscopic Techniques for Treatment of Consequences of Acute Necrotizing Pancreatitis: Practical Updates for the Endoscopist

2020 ◽  
Vol 9 (1) ◽  
pp. 117
Author(s):  
Mateusz Jagielski ◽  
Marian Smoczyński ◽  
Jacek Szeliga ◽  
Krystian Adrych ◽  
Marek Jackowski
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Minimally Invasive Treatment ◽  
Interventional Treatment ◽  
Endoscopic Drainage ◽  
Invasive Treatment ◽  
Endoscopic Techniques ◽  
Acute Necrotizing

Despite great progress in acute pancreatitis (AP) treatment over the last 30 years, treatment of the consequences of acute necrotizing pancreatitis (ANP) remains controversial. While numerous reports on minimally invasive treatment of the consequences of ANP have been published, several aspects of interventional treatment, particularly endoscopy, are still unclear. In this article, we attempt to discuss these aspects and summarize the current knowledge on endoscopic therapy for pancreatic necrosis. Endotherapy has been shown to be a safe and effective minimally invasive treatment modality in patients with consequences of ANP. The evolution of endoscopic techniques has made endoscopic drainage more effective and reduced the use of other minimally invasive therapies for pancreatic necrosis.

Video-assisted Laparoscopic Débridement for Retroperitoneal Pancreatic Collections: A Reliable Step-up Approach

2013 ◽  
Vol 79 (4) ◽  
pp. 429-433 ◽  
Author(s):  
Miguel Ángel García-Ureña ◽  
Javier López-Monclús ◽  
Daniel Melero-Montes ◽  
Luis Alberto Blázquez-Hernando ◽  
Camilo Castellón-Pavón ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Intraoperative Complications ◽  
Necrotizing Pancreatitis ◽  
Infected Pancreatic Necrosis ◽  
Icu Stay ◽  
Video Assisted ◽  
Acute Necrotizing ◽  
Lateral Decubitus ◽  
Positive Direct ◽  
Second Procedure

Several minimal access routes have been implemented as a step-up approach to treat infected pancreatic necrosis. We evaluate our experience with a series of consecutive patients with pancreatic collections treated with video-assisted retroperitoneal débridement (VARD). Seven patients were consecutively treated with VARD: five patients after acute necrotizing pancreatitis, one chronic pancreatitis, and one patient with perforation after endoscopic sphincterotomy. The indication for VARD was: development of sepsis, positive direct culture of the necrosis, and compartment syndrome. The procedure was performed under general anesthesia and modified lateral decubitus. There were four left, two right, and one bilateral VARD. Mean hospital stay since admission to VARD procedure was 30 days (range, 12 to 72 days). Mean operative time was 63 minutes. There were no intraoperative complications. Two patients needed a second procedure to control sepsis. Most patients had a long intensive care unit (ICU) stay with 6.1 days (range, 2 to 22 days) mean postoperative ICU stay. One patient had a hypernatremia as a consequence of saline lavage and three patients presented pancreatic fistula that were managed with conservative treatment. There was no mortality. VARD approach is a recommended step-up approach to treat infected pancreatic necrosis, and its indication may be extended to treat other retroperitoneal collections.

Laparoscopic Debridement of Recurrent Pancreatic Abscesses in the Hostile Abdomen

2006 ◽  
Vol 72 (6) ◽  
pp. 511-514 ◽  
Author(s):  
James M. Haan ◽  
Thomas M. Scalea
Keyword(s):  
Percutaneous Drainage ◽  
Pancreatic Pseudocyst ◽  
Pancreatic Necrosis ◽  
Irrigation System ◽  
Intraoperative Complications ◽  
Necrotizing Pancreatitis ◽  
Drainage Tube ◽  
Necrotic Tissue ◽  
Laparoscopic Drainage ◽  
Necrotic Debris

Recurrent necrotizing pancreatitis in the frozen or hostile abdomen remains a challenge. Percutaneous drainage is useful in these cases but often fails if there is significant pancreatic necrosis. We describe a technique for laparoscopic drainage of necrotic pancreas. The preexisting percutaneous drainage tract was sequentially dilated and a working thoracoscope was placed via a Hasson cannula. A pulsatile irrigation system was used to open the cavity for visualization and to wash away obvious necrotic debris. Working sequentially using the irrigation jet flow for debridement and visualization, we opened the entire tract and debrided a majority of the necrotic tissue. A large drainage tube was placed to allow the egress of any residual infection. Three patients to date have been treated with the above technique with no intraoperative complications. All three patients did well initially postoperatively and had adequate drainage. One patient developed a delayed pancreatic pseudocyst. Laparoscopic debridement via percutaneous drainage tract is a useful technique in the hostile abdomen.

scholarly journals Endoscopic transmural drainage and necrosectomy in acute necrotizing pancreatitis: A review

2021 ◽  
Vol 9 (3) ◽  
pp. 168-176
Author(s):  
Linlin Feng ◽  
Jintao Guo ◽  
Sheng Wang ◽  
Xiang Liu ◽  
Nan Ge ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Current Status ◽  
Endoscopic Drainage ◽  
Mortality And Morbidity ◽  
Endoscopic Techniques ◽  
Acute Necrotizing ◽  
Open Necrosectomy ◽  
Invasive Techniques

Abstract Acute necrotizing pancreatitis occurs in 10%–20% of patients with acute pancreatitis (AP) which is one of the most important acute abdominal diseases that require hospital admission. Pancreatic necrosis is also associated with high mortality and morbidity. In the past 20 years, the treatment of pancreatic necrosis has shifted from open necrosectomy to minimally invasive techniques, such as endoscopic interventions. With the development of endoscopic techniques, the safety and effectiveness of endoscopic interventions have improved, but there exist several unresolved problems. Currently, there is no unified standard approach for endoscopic treatment of pancreatic necrosis that takes into account local expertise, anatomical features of necrosis, patients’ preferences, and comorbidity profile. We reviewed the current status of endoscopic therapy for acute necrotizing pancreatitis, focusing on the new endoscopic drainage technique and necrosectomy protocol.

scholarly journals INFLUENCE OF SYSTEMIC INFLAMMATORY REACTIONS ON THE COURSE OF PANCREOECROSIS

2019 ◽  
Vol 42 (3) ◽  
pp. 64-68
Author(s):  
Boyko V. V. ◽  
Lichman V. N. ◽  
Shevchenko A. N. ◽  
Merkulov A. A. ◽  
Polikov H. O. ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Inflammatory Response ◽  
Inflammatory Reaction ◽  
Pancreatic Necrosis ◽  
Multiorgan Failure ◽  
Necrotizing Pancreatitis ◽  
Multiple Organ ◽  
Systemic Inflammatory Response ◽  
Systemic Inflammatory Reaction ◽  
Acute Necrotizing

Introduction. Acute pancreatitis is a common pathology in abdominal surgery, so the prevalence reaches 238 cases per million populations. It should be noted that pancreatic necrosis develops in 25% of patients with acute pancreatitis, and mortality can reach up to 20%. Purpose of the study. The investigate effect on the pancreatic necrosis course of the systemic inflammatory response. Materials and methods. We examined 96 patients aged from 19 to 78 years. During the course of the disease, a systemic inflammatory response developed in 79% of patients with acute necrotizing pancreatitis. Results. It was found that the lethal cases of acute necrotic pancreatitis occurred only with the development of multiple organ failure with a score of 6 or more on the SOFA scale. The correlation coefficients between the signs, affecting the risk of developing severe multiorgan failure, were calculated. It was proved that in case of a pronounced systemic inflammatory reaction, a patient produces a large amount of free fluid in the abdominal cavity, and is a risk of an early fatal outcome. It should be noted that in the presence of obesity there was a tendency to the risk of developing severe multiorgan failure. Conclusion. In acute necrotizing pancreatitis, the risk of severe multiorgan failure and death is only in patients with a systemic inflammatory reaction (especially in the presence of obesity and the elderly patient), and the degree of risk reliably depends on the severity of signs of an inflammatory response. Keywords: acute pancreatitis, pancreatic necrosis, systemic inflammatory response syndrome, multiple organ failure, septic complications.

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