Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis
Susanne Raczynski1, Niels Teich, Gudrun Borte
1Department of Medicine II, University of Leipzig, Leipzig, Germany.
Background:
Endoscopic drainage of pancreatic acute and chronic pseudocysts and pancreatic necrosectomy have been shown to be beneficial for critically ill patients, with complete endoscopic resolution rates of around 80%.
Objective:
Our purpose was to describe an improved endoscopic technique used to treat pancreatic necrosis.
Design:
Case report.
Setting:
University hospital.
Patients And Interventions:
Two patients with large retroperitoneal necroses were treated with percutaneous transgastric retroperitoneal flushing tubes and a percutaneous transgastric jejunal feeding tube by standard percutaneous endoscopic gastrostomy access in addition to endoscopic necrosectomy.
Results:
Intensive percutaneous transgastric flushing in combination with percutaneous normocaloric enteral nutrition and repeated endoscopic necrosectomy led to excellent outcomes in both patients.
Limitations:
Small number of patients.
Conclusions:
The "double percutaneous endoscopic gastrostomy" approach for simultaneous transgastric drainage and normocaloric enteral nutrition in severe cases of pancreatic necroses is safe and effective. It could be a promising improvement to endoscopic transgastric treatment options in necrotizing pancreatitis.
