Hybrid percutaneous-endoscopic necrosectomy for large walled-off pancreatic necrosis ‒ An observational feasibility
Elena Tenorio González1, Nada El-Domiaty1, Emilia Ragot2
1Gastroenterology, Georges-Pompidou European Hospital, France.
Background And Aim:
although direct endoscopic necrosectomy (DEN) by transgastric approach is accurate and sufficient in most patients presenting with infected walled-off necrosis (WON), some of them with very large and/or distal collections may need further therapies such as percutaneous endoscopic necrosectomy. Percutaneous hybrid necrosectomy (PHN) represents a new approach in these cases, combining the use of surgical clamps through the percutaneous fistula and a transgastric or percutaneous endoscopic guidance. The aim of this study was to analyze the impact of this innovative multidisciplinary technique on selected patients with WON.
Methods:
an observational single-center study was performed and all consecutive patients presenting with large WON who underwent PHN in 2019-2023 were included. A classification of early (< 3 previous DEN) or late PHN (≥ 3) was defined. The primary outcome was the clinical success, defined as symptom relief with WON complete resolution. The secondary aims were the time to WON resolution and the adverse event (AE) rate.
Results:
of 51 patients presenting with WON, 15 (mean age: 59 ± 12.7, 80 % male) underwent DEN combined with PHN and were included in the study. The median number of DEN sessions were two and most patients required only one single PHN procedure (n = 9, 60 %) during an interval time of eight days (range: 2-14). Clinical success was obtained in 14 cases (93.3 %). The time to WON resolution was lower in patients with an early PHN strategy (13 vs 30 days, p = 0.024). The overall per-procedure AE rate was 10.5 % during a median follow-up of 6.5 months (range: 3-49), with no procedure-related mortality.
Conclusions:
PHN under transgastric or percutaneous guidance represents a new minimally invasive and collaborative approach for selected patients with large WON. A low number of procedures is needed to achieve clinical success in a shorter time.
