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Pancreatic Necrosectomy through Sinus Tract Endoscopy.

Mahesh Kumar Goenka1, Usha Goenka2, Md Yasin Mujoo1

  • 1Institute of Gastrosciences, Apollo Gleneagles Hospitals, Kolkata, India.

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|January 5, 2018
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Summary

Sinus tract endoscopy (STE) offers a successful minimally invasive treatment for laterally-placed walled-off necrosis (WON). This technique, utilizing a gastroscope through a percutaneous drain, achieved high success rates with no mortality in a pilot study.

Keywords:
NecrosectomyPancreatitis, acute necrotizingSinus tract endoscopyWalled-off necrosis

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Area of Science:

  • Gastroenterology
  • Interventional Endoscopy
  • Pancreatic Diseases

Background:

  • Direct endoscopic pancreatic necrosectomy is common for WON near the stomach/duodenum.
  • Laterally-placed WON traditionally requires surgery.
  • Sinus tract endoscopy (STE) is an underutilized technique for laterally-placed WON.

Purpose of the Study:

  • To evaluate the efficacy of STE for symptomatic, laterally-placed walled-off necrosis (WON).

Main Methods:

  • STE was performed using a standard gastroscope via a percutaneous tract with a 32-Fr drain.
  • Ten patients with laterally-placed WON were treated with STE.
  • The mean number of sessions was 2.3, with an average duration of 70 minutes per session.

Main Results:

  • Nine out of ten patients achieved complete success with STE.
  • One patient required surgery due to persistent fever.
  • Two patients experienced pneumoperitoneum, managed conservatively, with no mortality or recurrence observed.

Conclusions:

  • STE is a viable and successful management option for laterally-placed WON.
  • Further research is needed to refine STE techniques and define treatment endpoints.