Drain Irrigation with Vacuum Assistance Necrosectomy in Necrotizing Pancreatitis

To compare traditional minimally invasive treatments for necrotizing pancreatitis with a novel percutaneous approach, drain irrigation with vacuum assistance (DIVA) necrosectomy.

In this retrospective, single-center study, 20 patients with necrotizing pancreatitis treated with minimally invasive necrosectomy between June 2022 and June 2024 at a tertiary care center were reviewed: 6 received DIVA, and 14 received video-assisted retroperitoneal debridement (VARD) or endoscopic transgastric necrosectomy (ETN). In the DIVA procedure, a suction device is inserted in a mature drain tract in tandem with an irrigation catheter, and vacuum debridement is performed with negative pressure reaching 98.9 kPa. Demographic data and preprocedural severity were recorded. The number of procedures each patient underwent, time to imaging resolution, and the number and nature of adverse events experienced were compared between the DIVA and VARD/ETN groups.

Patients who underwent DIVA had higher disease severity at presentation (Acute Physiology and Chronic Health Evaluation II score, 15.0 vs 6.5; P = .012) and reached resolution of abdominal fluid collections more quickly (48.8 days vs 110.1 days, P = .017). DIVA patients all reached resolution, whereas only 12 (86%) of 14 VARD/ETN reached resolution. Additionally, DIVA trended toward fewer adverse events, although this difference was not statistically significant (risk ratio, 0.20; 95% CI, 0.03-1.5; P = .161).

Despite higher disease severity at presentation, patients undergoing image-guided DIVA necrosectomy experienced a faster resolution than VARD/ETN patients. These preliminary results warrant further research into DIVA's role in treatment of necrotizing pancreatitis.