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A standardized method for endoscopic necrosectomy improves complication and mortality rates.

Christopher C Thompson1, Nitin Kumar1, James Slattery1

  • 1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis St., ASB II, Boston, MA 02115, USA.

Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [Et Al.]
|January 11, 2016
PubMed
Summary

A standardized endoscopic necrosectomy approach for walled-off necrosis (WON) significantly reduced complication and mortality rates. This systematic method improved patient outcomes and may encourage wider adoption of the technique.

Keywords:
Direct endoscopic necrosectomy (DEN)NecrosectomyPancreatitisPseudocystWalled-off necrosis (WON)Walled-off pancreatic necrosis (WOPN)

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Area of Science:

  • Gastroenterology
  • Interventional Endoscopy
  • Surgical Necrosis Management

Background:

  • Endoscopic necrosectomy is a preferred treatment for walled-off necrosis (WON) over surgery.
  • High complication and mortality rates, along with a lack of standardized protocols, limit its widespread adoption.

Purpose of the Study:

  • To develop and assess a standardized, systematic approach for endoscopic necrosectomy in managing WON.
  • To evaluate the clinical outcomes, including adverse events and mortality, of this standardized technique.

Main Methods:

  • A multidisciplinary team developed a standardized protocol for preoperative, postoperative, and endoscopic management of WON.
  • The protocol included specific techniques such as EUS-guidance, balloon dilation, initial debridement, antibiotic lavage, and stent placement, along with PPI discontinuation.
  • A consecutive prospective clinical registry was used to evaluate patient outcomes.

Main Results:

  • 60 patients underwent endoscopic necrosectomy with a mean of 1.58 sessions.
  • 98.3% achieved debridement during the initial procedure, and 65% required only one session.
  • Clinical resolution was achieved in 86.7% of patients, with a low rate of serious adverse events (3.3%) and no mortality.

Conclusions:

  • The standardized endoscopic necrosectomy technique resulted in lower adverse event, morbidity, and mortality rates compared to previous large series.
  • Implementing a systematic approach with standardized elements can improve the risk profile of endoscopic necrosectomy.
  • This standardized method holds the potential for broader adoption in managing WON.