Endoscopic necrosectomy under fluoroscopic guidance - a single center experience

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Interventional Endoscopy

Background:

• Walled-off pancreatic necrosis (WOPN) is a serious complication of pancreatitis.
• Traditional treatment often involves invasive surgical procedures.
• Minimally invasive endoscopic techniques offer an alternative for managing WOPN.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic necrosectomy during transmural drainage for symptomatic WOPN.
• To present an alternative technique for necrotic tissue removal in WOPN management.

Main Methods:

• Retrospective analysis of 64 patients with symptomatic WOPN treated endoscopically between 2012-2013.
• Eight patients underwent endoscopic necrosectomy using a Dormia basket under fluoroscopic guidance.
• Transmural drainage was established via transgastric or transduodenal access.

Main Results:

• Endoscopic necrosectomy was performed in 8 patients (12.5%) with symptomatic WOPN.
• Average drainage duration was 24 days, with a mean of 4.75 endoscopic procedures.
• Therapeutic success was achieved in all patients, with no recurrence during 6-month follow-up. Complications (25%) were unrelated to necrosectomy.

Conclusions:

• Endoscopic necrosectomy during transmural drainage is a safe and effective minimally invasive treatment for selected WOPN patients.
• This technique provides a successful alternative to traditional surgical interventions.
• Fluoroscopic guidance is crucial for effective necrotic tissue removal.