Direct Endoscopic Necrosectomy With and Without Hydrogen Peroxide for Walled-off Pancreatic Necrosis: A Multicenter
Ahmed A Messallam1, Douglas G Adler, Raj J Shah
11Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; 2Division Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA; 3Division Gastroenterology and Hepatology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; 4Borland-Groover Clinic, Jacksonville, Florida, USA; 5Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA; 6Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA; 7Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburg, Pennsylvania, USA; 8Division of Gastroenterology, Hepatology and Nutrition, The Ohio state University Wexner Medical Center, Columbus, Ohio, USA; 9Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA; 10Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA; 11Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Introduction:
Endoscopic necrosectomy has emerged as the preferred treatment modality for walled-off pancreatic necrosis. This study was designed to evaluate the safety and efficacy of direct endoscopic necrosectomy with and without hydrogen peroxide (H2O2) lavage.
Methods:
Retrospective chart reviews were performed for all patients undergoing endoscopic transmural management of walled-off pancreatic necrosis at 9 major medical centers from November 2011 to August 2018. Clinical success was defined as the resolution of the collection by imaging within 6 months, without requiring non-endoscopic procedures or surgery.
Results:
Of 293 patients, 204 met the inclusion criteria. Technical and clinical success rates were 100% (204/204) and 81% (166/189), respectively. For patients, 122 (59.8%) patients had at least one H2O2 necrosectomy (H2O2 group) and 82 (40.2%) patients had standard endoscopic necrosectomy. Clinical success was higher in the H2O2 group: 106/113 (93.8%) vs 60/76 (78.9%), P = 0.002. On a multivariate analysis, the use of H2O2 was associated with higher clinical success rate (odds ratio 3.30, P = 0.033) and earlier resolution (odds ratio 2.27, P < 0.001). During a mean follow-up of 274 days, 27 complications occurred. Comparing procedures performed with and without H2O2 (n = 250 vs 183), there was no difference in post-procedure bleeding (7 vs 9, P = 0.25), perforation (2 vs 3, P = 0.66), infection (1 vs 2, P = 0.58), or overall complication rate (n = 13 [5.2%] vs 14 [7.7%], P = 0.30).
Discussion:
H2O2-assisted endoscopic necrosectomy had a higher clinical success rate and a shorter time to resolution with equivalent complication rates relative to standard necrosectomy.See the visual abstract at http://links.lww.com/AJG/B714.(Equation is included in full-text article.).
