Complications Requiring Abdominal Surgery in Endoscopically Treated Patients With Pancreatic Walled-off Necrosis:...

Although surgery has a limited role in the treatment of pancreatic walled-off necrosis (WON), complications may arise during endoscopic treatment that require surgical intervention. Likewise, insufficient endoscopic debridement may necessitate surgical step-up. The aim of this study was to evaluate complications necessitating abdominal surgery in patients undergoing endoscopic treatment for symptomatic WON.

In this retrospective study, we reviewed consecutive patients with WON treated endoscopically at a tertiary referral center during a 10-year period to identify cases who required abdominal emergency surgery.

A total of 271 patients with WON were included, of whom 24 (9%) developed abdominal complications requiring surgical intervention. Eight patients underwent surgery before endoscopic intervention and 16 (66%) after. The most prevalent complication was intestinal ischemia in 11 cases (46%), bleeding in 4 cases (17%), intestinal perforation in 3 cases (13%), bowel stenosis in 3 cases (13%), and fistula in 3 cases (13%). The mortality during admission did not differ significantly between patients requiring surgery and patients who did not (20.8% vs 13.8%, P = 0.392).

This study demonstrates that complications requiring abdominal surgery in patients undergoing endoscopic treatment for WON occur in one of 10 patients, intestinal ischemia being the most frequent cause of intervention.