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 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.

The burden of acute pancreatitis and early experience of step-up approach for acute necrotizing pancreatitis at Military Hospital

2019 ◽  
Vol 22 (2) ◽  
pp. 11-17
Author(s):  
Sushil Bahadur Rawal ◽  
Uttam Laudari ◽  
Basanta Khatiwada ◽  
Anup Thapa ◽  
Manoj Kumar Jha ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Early Experience ◽  
Acute Necrotizing Pancreatitis ◽  
Military Hospital ◽  
Army Hospital ◽  
Acute Necrotizing ◽  
Hospital Resources ◽  
Open Necrosectomy

Introduction: Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach. Methods: A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied. Results: Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them, three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy. Conclusion: Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

Su1459 PREDICTORS OF MORTALITY AND MORBIDITY IN PATIENTS WITH ACUTE NECROTIZING PANCREATITIS.

2020 ◽  
Vol 158 (6) ◽  
pp. S-586-S-587 ◽  
Author(s):  
C. Roberto Simons-Linares ◽  
Vibhu Chittajallu ◽  
Ariel Sims ◽  
Christian Cuvillier ◽  
Mohannad Abou Saleh ◽  
...  
Keyword(s):  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Mortality And Morbidity ◽  
Predictors Of Mortality ◽  
Acute Necrotizing

Su1403 Surgical Transgastric Necrosectomy for Symptomatic Pancreatic Necrosis in Acute Necrotizing Pancreatitis

2016 ◽  
Vol 150 (4) ◽  
pp. S1213-S1214
Author(s):  
Jessica Cioffi ◽  
Jose Trevino ◽  
Steven J. Hughes ◽  
Kevin E. Behrns
Keyword(s):  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Acute Necrotizing

scholarly journals ARROSIVE BLEEDING WITH PANCREATIC NECROSIS — TACTICAL APPROACHES

2020 ◽  
pp. 85-88 ◽  
Author(s):  
V. V. Mishchenko ◽  
P. I. Pustovoit ◽  
R. Yu. Vododyuk ◽  
V. V. Velichko ◽  
V. V. Goryachy
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Stent Grafts ◽  
Invasive Treatment ◽  
Results Of Treatment ◽  
Hemorrhagic Complications ◽  
Necrotic Pancreatitis ◽  
Acute Necrotizing

Summary. The problem of hemorrhagic complications of destructive pancreatitis is relevant. The aim of the study was to study the frequency and sources of hemorrhagic complications in patients with pancreatic necrosis, to evaluate the tactics of diagnosis and the effectiveness of methods to stop bleeding. Materials and methods. A study of the results of treatment of 40 patients with acute necrotizing pancreatitis was conducted. Results and its discussion. In 67.5 % of patients with acute necrotizing pancreatitis, hemorrhagic complications in the form of arrosive bleeding were observed. A method of endovascular occlusion of vessels using Gianturco spirals or stent grafts to stop arrosive bleeding in acute necrotizing pancreatitis has been introduced in the clinic. In 37.0 % of cases, repeated signs of arrosive bleeding were observed. In acute necrotizing pancreatitis complicated by arrosive bleeding, mortality was 44.4 %. Conclusions. The main cause of hemorrhagic complications in acute necrotic pancreatitis is acute necrotic changes, during infection of which arrosia of adjacent vessels occurs. The predominant tactic in case of bleeding from the retroperitoneal space against the background of minimally invasive treatment is clamping of drains, endovascular hemostasis using Gianturco spirals or stent grafts and the use of hemostatic soluble gauze (hemostop). Mortality in the development of arrosive bleeding in acute necrotic pancreatitis is 44.4 %.

scholarly journals The Emphysematous Pancreatitis: A Rare Complication of Acute Necrotizing Pancreatitis

2020 ◽  
Author(s):  
Niryinganji Révérien ◽  
Mountassir Shuruk ◽  
Siwane Abdellatif ◽  
Tabakh Houria ◽  
Touil Najwa ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Pancreatic Necrosis ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Necrotizing Pancreatitis ◽  
Biological Evolution ◽  
Acute Necrotizing Pancreatitis ◽  
Air Bubbles ◽  
Fatal Complication ◽  
Acute Necrotizing

Emphysematous pancreatitis is a rare and fatal complication of acute necrotizing pancreatitis. We report a radioclinical observation of a 61-year-old female patient who consulted for epigastric pain radiating to the back, associated with vomiting and elevated lipasaemia more than 3 times the normal value. The abdominal computerized tomography (CT) scan carried out on the fourth day of hospitalization, based on worsening of the clinical condition, showed pancreatic necrosis associated with the presence of air bubbles. Percutaneous puncture of a peripancreatic collection was positive for Escherichia coli. A diagnosis of emphysematous pancreatitis was established. The clinical and biological evolution of our patient was favourable with antibiotic treatment.

scholarly journals The Role of Open Necrosectomy in the Current Management of Acute Necrotizing Pancreatitis: A Review Article

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
K. Vasiliadis ◽  
C. Papavasiliou ◽  
A. Al Nimer ◽  
N. Lamprou ◽  
C. Makridis
Keyword(s):  
Organ Failure ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Intensive Care Treatment ◽  
Primary Therapy ◽  
Septic Complications ◽  
Operative Strategy ◽  
Acute Necrotizing ◽  
Open Necrosectomy

The optimal management of necrotizing pancreatitis continues to evolve. Currently, conservative intensive care treatment represents the primary therapy of acute severe necrotizing pancreatitis, aiming at prevention of organ failure. Following this mode of treatment most patients with sterile necroses can be managed successfully. Surgery might be considered as an option in the late phase of the disease for patients with proven infected pancreatic necroses and organ failure. For these patients surgical debridement is still considered the treatment of choice. However, even for this subgroup of patients, the concept of operative strategy has been recently challenged. Nowadays, it is generally accepted that necrotizing pancreatitis with proven infected necroses as well as septic complications directly caused by pancreatic infection are strong indications for surgical management. However, the question of the most appropriate surgical technique for the treatment of pancreatic necroses remains unsettled. At the same time, recent advances in radiological imaging, new developments in interventional radiology, and other minimal access interventions have revolutionised the management of necrotizing pancreatitis. In light of these controversies, the present paper will focus on the current role of surgery in terms of open necrosectomy in the management of severe acute necrotizing pancreatitis.

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