Outcomes in Endoscopic and Operative Transgastric Pancreatic Debridement

Area of Science:

• Gastroenterology
• Surgical Innovation
• Pancreatic Disease Management

Background:

• Necrotizing pancreatitis (NP) is a severe condition requiring intervention.
• Transgastric debridement (TGD) is a treatment option for select NP patients.
• Limited comparative data exists for endoscopic versus operative TGD.

Purpose of the Study:

• To compare the outcomes of endoscopic transgastric debridement (Endo-TGD) and operative transgastric debridement (OR-TGD) for walled-off pancreatic necrosis.
• To evaluate procedural differences, complication rates, and patient outcomes between the two TGD approaches.

Main Methods:

• A retrospective analysis of patients undergoing TGD for NP between 2008 and 2019 at a high-volume pancreatic center.
• Comparison of patient demographics, procedural details, and clinical outcomes between Endo-TGD and OR-TGD groups.
• Statistical analysis to identify significant differences in debridements per patient, readmissions, repeat interventions, length of stay, organ failure, and mortality.

Main Results:

• Of 160 TGD procedures, 59 were Endo-TGD and 101 were OR-TGD. Patient characteristics were similar between groups.
• OR-TGD required significantly fewer debridements per patient (1.1 vs. 3.0) and resulted in fewer hospital readmissions and repeat interventions.
• OR-TGD patients had a shorter total inpatient length of stay (9.4 vs. 13.8 days) and lower mortality (1% vs. 7%) compared to Endo-TGD patients. New-onset organ failure was similar (13% in both).

Conclusions:

• Both Endo-TGD and OR-TGD are effective in resolving pancreatic necrosis but differ in procedural profiles and outcomes.
• OR-TGD appears associated with fewer interventions, shorter hospital stays, and reduced mortality.
• Multidisciplinary communication is crucial for selecting the optimal TGD approach for individual NP patients.