scholarly journals Direct Endoscopic Necrosectomy: Timing and Technique

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1305
Author(s):  
Sergio Pinto ◽  
Saverio Bellizzi ◽  
Roberta Badas ◽  
Maria Laura Canfora ◽  
Erica Loddo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Outcome ◽  
Adverse Events ◽  
Hospital Stay ◽  
Pancreatic Necrosis ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Endoscopic Necrosectomy ◽  
Interventional Techniques ◽  
Local Complications

Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this narrative review is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.

scholarly journals Endoscopic necrosectomy of walled-off pancreatic necrosis by large-bore percutaneus metal stent: a new opportunity?

2018 ◽  
Vol 06 (03) ◽  
pp. E274-E278 ◽  
Author(s):  
Andrea Tringali ◽  
Salvatore Vadalà di Prampero ◽  
Vincenzo Bove ◽  
Vincenzo Perri ◽  
Antonio La Greca ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Duodenal Wall ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Percutaneous Approach ◽  
Endoscopic Necrosectomy

Abstract Background and study aims Endoscopic drainage of walled-off pancreatic necrosis (WOPN) is feasible when contact with the gastric or duodenal wall is present; when WOPN cannot be accessed endoscopically, a percutaneous approach can be considered. Percutaneous use of esophageal self-expandable metal stents (SEMS) to establish access to a WOPN cavity was evaluated.

scholarly journals SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323364
Author(s):  
Sanjay Pandanaboyana ◽  
John Moir ◽  
John S Leeds ◽  
Kofi Oppong ◽  
Aditya Kanwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Organ Failure ◽  
Collaborative Study ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Local Complications ◽  
Persistent Organ Failure ◽  
Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

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 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 A prospective study to predict the severity of acute pancreatitis by BISAP score

2017 ◽  
Vol 4 (7) ◽  
pp. 2221
Author(s):  
Yogesh Kumar Bung ◽  
Chandrasekhar Sharanappa Neeralagi ◽  
Lakkanna Suggaiah ◽  
Usharani Rathnam ◽  
Chandrakant Kesari
Keyword(s):  
Acute Pancreatitis ◽  
Mortality Rate ◽  
Prospective Study ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Medical Science ◽  
Fisher Exact Test ◽  
Local Complications ◽  
Increased Risk ◽  
A Prospective Study

Background: Acute pancreatitis (AP) is as an inflammation of the pancreas with varied range of complication like peri-pancreatic collection, pancreatic necrosis, renal failure, multi-organ dysfunction syndrome which increases mortality rate and morbidity. Majority of AP cases are mild but severe cases of AP are associated with increased complication and mortality. BISAP is simple bedside prognostic scoring system for predicting severity of AP. BISAP is a collection of simple routine investigation and scores are quantified at 24hours of onset of AP. This study aims to assess prognosis of AP cases at ESIC Medical college and Post Graduate Institute of Medical Science and Research, Bangalore, Karnataka, India.Methods: A prospective study of 60 Patients who were diagnosed as AP according to RAC. All patients were admitted in high dependency unit with close observation of vital parameters and investigations were done at 24 hours of onset of AP. BISAP score >3 was considered as Severe Acute Pancreatitis, its correlation with local complications, organ failure, ICU stay and Mortality was studied. Statistical analysis done using Chi-square test and Fisher Exact test for local complications and organ failure using xL Stat and SPSS v.21.0, a p-value <0.05 was considered to be significant.Results: Of the 60 patients, BISAP score was >3 and <3 in 15 and 45 patients respectively. Alcohol was the most common cause of acute pancreatitis, accounting for 53.33%. In current study 12 (20%) patients developed organ failure and among them 9 (75%) had transient organ failure and 3 (25%) had persistent organ failure. Total 8 (13%) patients had developed pancreatic necrosis and among them 6 had BISAP >3. Mortality rate in this study was 2%.Conclusions: The BISAP score is a simple and fairly accurate method for the early identification of patients at increased risk for in hospital mortality and to identify patients at risk of the development of intermediate markers of severity and organ failure within 24 hours of presentation.

Accuracy of bedside index for severity in acute pancreatitis ‘BISAP’ score in predicting outcome of acute pancreatitis

2020 ◽  
Vol 7 (2) ◽  
pp. 70-76
Author(s):  
Sanjit Karki ◽  
Binod Karki ◽  
Suresh Thapa ◽  
Roshan Shrestha ◽  
Bidhan Nidhi Poudel ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Predictive Model ◽  
Early Identification ◽  
Pancreatic Necrosis ◽  
Local Population ◽  
Length Of Hospital Stay ◽  
Receiver Operating Curve ◽  
Severe Pancreatitis ◽  
Predicting Outcome

Introduction: Early identification of severe acute pancreatitis is of paramount importance in the management and for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP) is a simple and accurate score for stratification in acute pancreatitis. This study was conducted to find out the accuracy of BISAP score in predicting outcomes of acute pancreatitis in local population. Method: We prospectively analyzed 96 patients with acute pancreatitis from February 2019 to December 2019. Revised Atlanta classification was used to stratify mild, moderately severe and severe pancreatitis. BISAP score was calculated within 24 hours of admission. Accuracy was measured by area under receiver operating curve (AUC). Result: Out of 96 patients, alcohol related acute pancreatitis accounted for 74.7%. There were 63.2% of mild AP, 37.3% of moderately severe AP, 9.4% of severe AP and 15.8 % of pancreatic necrosis. The AUC for moderately severe AP, severe AP and pancreatic necrosis were 0.77 (CI 0.68-0.87), 0.95 (CI 0.90-0.99) and 0.87 (CI 0.79-0.96) respectively. The statistically significant BISAP cut off for diagnosing sever AP was≥3, and ≥2 for moderately sever AP and pancreatic necrosis. There was positive correlation between revised Atlanta severity of acute pancreatitis and length of hospital stay (r=0.41). Mortality was 3.3 % which was seen in BISAP score 3 or above. Conclusion: BISAP is a simple predictive model in identifying patient at a risk of developing different severity of pancreatitis and its outcome in our population.

scholarly journals Clinical impact of EUS treatment of walled-off pancreatic necrosis with dedicated devices

2017 ◽  
Vol 05 (08) ◽  
pp. E784-E791 ◽  
Author(s):  
Ilaria Tarantino ◽  
Dario Ligresti ◽  
Fabio Tuzzolino ◽  
Luca Barresi ◽  
Gabriele Curcio ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pancreatic Necrosis ◽  
Clinical Success ◽  
Length Of Hospital Stay ◽  
Multiple Organ ◽  
Technical Success ◽  
Stent Deployment ◽  
Invasive Approach ◽  
Endoscopic Necrosectomy ◽  
Stent Retrieval

Abstract Background and study aims Walled-off pancreatic necrosis (WOPN) represents the major risk factor for sepsis-related multiple organ failure. Surgical debridement is an invasive approach associated with high rates of adverse events (AEs) and death. As an alternative, endoscopic ultrasound-guided cysto-gastro-anastomosis has emerged as an effective treatment for WOPNs. Recently a new dedicated-lumen apposing metal stent (LAMS) has been used with satisfactory results in treating peri-pancreatic fluid collections, including WOPNs. The primary outcomes of this study were to evaluate survival and clinical success. Secondary outcomes included: technical success, adverse events and recurrence rate. Patients and methods All consecutive patients with infected WOPN between February 2014 and June 2016 were retrospectively reviewed. Patients underwent placement of a new LAMS incorporated in an electrocautery-enhanced delivery system and direct endoscopic necrosectomy (DEN). DEN was performed immediately after stent deployment and repeated every 3 to 7 days until complete resolution. Results In the study period we treated 20 consecutive patients with infected WOPN using the new LAMS. Technical success was achieved in 95 % of patients. Clinical success was achieved in 73 % and 84.2 % of patients at 1 and 3 months, respectively. Survival rate was 84.2 % and 79 %. Mean length of hospital stay was 19 days (range 3 – 43). No AEs occurred. Patients were followed up after stent retrieval for a mean time of 554,7 days (range 70 – 986) and no recurrence was observed. Conclusions DEN following “1-step, exchange-free” LAMS positioning recorded excellent results. We believe that simplicity of procedure plays a key role in terms of safety.

scholarly journals A comparison of outcomes between a lumen-apposing metal stent with electrocautery-enhanced delivery system and a bi-flanged metal stent for drainage of walled-off pancreatic necrosis

2017 ◽  
Vol 05 (12) ◽  
pp. E1189-E1196 ◽  
Author(s):  
Noor Bekkali ◽  
Manu Nayar ◽  
John Leeds ◽  
Richard Charnley ◽  
Matthew Huggett ◽  
...  
Keyword(s):  
Adverse Events ◽  
Delivery System ◽  
Pancreatic Necrosis ◽  
Clinical Success ◽  
Stent Migration ◽  
Metal Stents ◽  
Procedure Time ◽  
Metal Stent ◽  
End Point ◽  
Significant Difference

Abstract Background and study aims Bi-flanged metal stents (BFMS) have shown promise in the drainage of walled-off pancreatic necrosis (WON), but their placement requires multiple steps and the use of other devices. More recently, a novel device consisting of a combined lumen-apposing metal stent (LAMS) and electrocautery-enhanced delivery system has been introduced. The aim of this study was to compare the placement and outcomes of the two devices. Patients and methods This was a retrospective review of consecutive patients undergoing endoscopic ultrasound-guided placement of BFMS or LAMS for drainage of symptomatic WON. Data from procedures between October 2012 and December 2016 were taken from a prospectively maintained database. We compared technical and clinical success, procedure time, costs, and composite end point of significant events (adverse events, stent migration, additional percutaneous drainage) between BFMS and LAMS. Results 72 consecutive patients underwent placement of BFMS (40 patients, 44 stents) or LAMS (32 patients, 33 stents). Technical success was 91 % for BFMS and 97 % for LAMS. Clinical success was 65 % vs. 78 %, respectively. Median in-room procedure time was significantly shorter in the LAMS group (45 minutes [range 30 – 80]) than in the BFMS group (62.5 minutes [range 35 – 135]; P < 0.001) and fewer direct endoscopic necrosectomies (DEN) were performed (median 1 [0 – 2.0] vs. 2 [0 – 3.7], respectively; P = 0.005). If only inpatients were considered (35 BFMS and 19 LAMS), there was no significant difference in DEN 2 (range 0 – 11) and 2 (range 0 – 8), respectively. The composite end point of 32 % vs. 24 % was not significantly different. Median procedural costs for all patients with successful stent placement for WON treatment was €4427 (range 1630 – 12 926) for BFMS vs. €3500 (range 2509 – 13 393) for LAMS (P = 0.10). Conclusion LAMS was superior to BFMS in terms of procedure time, with comparable adverse events, success, and costs.

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