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Certain organic substances change color in dilute solution when the hydronium ion concentration reaches a particular value. For example, phenolphthalein is a colorless substance in any aqueous solution with a hydronium ion concentration greater than 5.0 × 10−9 M (pH < 8.3). In more basic solutions where the hydronium ion concentration is less than 5.0 × 10−9 M (pH > 8.3), it is red or pink. Substances such as phenolphthalein, which can be used to determine the pH of a solution, are...
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Endoscopic Transmural Necrosectomy: Timing, Indications, and Methods.

Rungsun Rerknimitr1,2

  • 1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

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|September 19, 2019
PubMed
Summary
This summary is machine-generated.

Walled-off necrosis, a severe pancreatitis complication, is increasingly treated with endoscopic necrosectomy. Lumen-apposing stents offer a minimally invasive, effective approach, reducing treatment sessions and improving outcomes.

Keywords:
Endoscopic necrosectomyLumen-apposing metallic stentWalled-off necrosis

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Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Complications
  • Minimally Invasive Procedures

Background:

  • Walled-off necrosis is a severe complication of acute pancreatitis.
  • Traditional treatments include percutaneous drainage and open surgery.
  • Endoscopic necrosectomy has emerged as a preferred alternative.

Purpose of the Study:

  • To review the evolution and effectiveness of endoscopic necrosectomy for walled-off necrosis.
  • To highlight the advantages of lumen-apposing stents in endoscopic therapy.
  • To discuss the step-up treatment strategy in managing this complication.

Main Methods:

  • Review of current endoscopic techniques for walled-off necrosis.
  • Comparison of different stent types (plastic, metallic, lumen-apposing).
  • Analysis of the step-up approach and multi-gateway endoscopic therapy.

Main Results:

  • Endoscopic necrosectomy is a favorable approach compared to traditional methods.
  • Lumen-apposing stents facilitate direct endoscopic necrosectomy.
  • Fewer treatment sessions are typically required with lumen-apposing stents.

Conclusions:

  • Endoscopic necrosectomy, particularly with lumen-apposing stents, represents an advancement in treating walled-off necrosis.
  • The step-up strategy remains crucial, with lumen-apposing stents enhancing its efficacy.
  • Minimally invasive endoscopic techniques are becoming the standard of care.