Transcutaneous Endoscopic Necrosectomy for Walled-off Pancreatic Necrosis in the Paracolic Gutter

Monica Saumoy; Nikhil A. Kumta; Amy Tyberg; Elizabeth Brown; Micheal D. Lieberman; Soumitra R. Eachempati; Ronald S. Winokur; Monica Gaidhane; Reem Z. Sharaiha; Michel Kahaleh

doi:https://doi.org/10.1097/MCG.0000000000000895

Transcutaneous Endoscopic Necrosectomy for Walled-off Pancreatic Necrosis in the Paracolic Gutter

Monica Saumoy, Nikhil A. Kumta, Amy Tyberg, Elizabeth Brown, Micheal D. Lieberman, Soumitra R. Eachempati, Ronald S. Winokur, Monica Gaidhane, Reem Z. Sharaiha, Michel Kahaleh

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Walled-off pancreatic necrosis (WON) is a sequelae of acute pancreatitis that requires debridement, once infected. Recently, endoscopic necrosectomy has become the mainstay for management. However, peripancreatic collections that extend to the paracolic gutter or lesser sac, are more challenging to treat endoscopically. We report an endoscopic method for management of necrotic collections that extend into the paracolic gutter. Methods: Consecutive patients, with symptomatic WON extending into the retroperitoneum, were included in a prospective registry. Each patient underwent transcutaneous endoscopic necrosectomy (TEN) through a fully covered self-expanding esophageal metal stent. After resolution of the collection, the external stent was removed, and the cutaneous fistula was allowed to close by secondary intention. Clinical success was defined as resolution of the WON, and successful removal of all percutaneous drains. Patient demographics, procedural/periprocedural adverse events, and follow-up data, were collected. Results: Nine patients underwent direct TEN. Patients initially underwent CT-guided percutaneous drainage, with an average of 31 days between initial drainage and endoscopic necrosectomy. All patients had a technically successful placement of a fully covered esophageal metal stent through the cutaneous fistula. After a median of 3 endoscopic debridement sessions, 8 of 9 (89%) patients had successful removal of all percutaneous drains, and resolution of necrotic collections. One patient died of multisystem organ failure from severe acute pancreatitis. Conclusions: TEN for infected WON is a safe and efficacious technique for patients with endoscopically inaccessible collections.

Original language	English (US)
Pages (from-to)	458-463
Number of pages	6
Journal	Journal of Clinical Gastroenterology
Volume	52
Issue number	5
DOIs	https://doi.org/10.1097/MCG.0000000000000895
State	Published - 2018
Externally published	Yes

ASJC Scopus subject areas

Gastroenterology

Keywords

endoscopic necrosectomy
necrotizing pancreatitis
walled-off pancreatic necrosis

Access to Document

https://doi.org/10.1097/MCG.0000000000000895

Cite this

@article{53995d9f511c4d74ab2f12b9b578b1aa,

title = "Transcutaneous Endoscopic Necrosectomy for Walled-off Pancreatic Necrosis in the Paracolic Gutter",

abstract = "Background: Walled-off pancreatic necrosis (WON) is a sequelae of acute pancreatitis that requires debridement, once infected. Recently, endoscopic necrosectomy has become the mainstay for management. However, peripancreatic collections that extend to the paracolic gutter or lesser sac, are more challenging to treat endoscopically. We report an endoscopic method for management of necrotic collections that extend into the paracolic gutter. Methods: Consecutive patients, with symptomatic WON extending into the retroperitoneum, were included in a prospective registry. Each patient underwent transcutaneous endoscopic necrosectomy (TEN) through a fully covered self-expanding esophageal metal stent. After resolution of the collection, the external stent was removed, and the cutaneous fistula was allowed to close by secondary intention. Clinical success was defined as resolution of the WON, and successful removal of all percutaneous drains. Patient demographics, procedural/periprocedural adverse events, and follow-up data, were collected. Results: Nine patients underwent direct TEN. Patients initially underwent CT-guided percutaneous drainage, with an average of 31 days between initial drainage and endoscopic necrosectomy. All patients had a technically successful placement of a fully covered esophageal metal stent through the cutaneous fistula. After a median of 3 endoscopic debridement sessions, 8 of 9 (89%) patients had successful removal of all percutaneous drains, and resolution of necrotic collections. One patient died of multisystem organ failure from severe acute pancreatitis. Conclusions: TEN for infected WON is a safe and efficacious technique for patients with endoscopically inaccessible collections.",

keywords = "endoscopic necrosectomy, necrotizing pancreatitis, walled-off pancreatic necrosis",

author = "Monica Saumoy and Kumta, {Nikhil A.} and Amy Tyberg and Elizabeth Brown and Lieberman, {Micheal D.} and Eachempati, {Soumitra R.} and Winokur, {Ronald S.} and Monica Gaidhane and Sharaiha, {Reem Z.} and Michel Kahaleh",

year = "2018",

doi = "https://doi.org/10.1097/MCG.0000000000000895",

language = "English (US)",

volume = "52",

pages = "458--463",

journal = "Journal of Clinical Gastroenterology",

issn = "0192-0790",

publisher = "Lippincott Williams and Wilkins",

number = "5",

}

TY - JOUR

T1 - Transcutaneous Endoscopic Necrosectomy for Walled-off Pancreatic Necrosis in the Paracolic Gutter

AU - Saumoy, Monica

AU - Kumta, Nikhil A.

AU - Tyberg, Amy

AU - Brown, Elizabeth

AU - Lieberman, Micheal D.

AU - Eachempati, Soumitra R.

AU - Winokur, Ronald S.

AU - Gaidhane, Monica

AU - Sharaiha, Reem Z.

AU - Kahaleh, Michel

PY - 2018

Y1 - 2018

N2 - Background: Walled-off pancreatic necrosis (WON) is a sequelae of acute pancreatitis that requires debridement, once infected. Recently, endoscopic necrosectomy has become the mainstay for management. However, peripancreatic collections that extend to the paracolic gutter or lesser sac, are more challenging to treat endoscopically. We report an endoscopic method for management of necrotic collections that extend into the paracolic gutter. Methods: Consecutive patients, with symptomatic WON extending into the retroperitoneum, were included in a prospective registry. Each patient underwent transcutaneous endoscopic necrosectomy (TEN) through a fully covered self-expanding esophageal metal stent. After resolution of the collection, the external stent was removed, and the cutaneous fistula was allowed to close by secondary intention. Clinical success was defined as resolution of the WON, and successful removal of all percutaneous drains. Patient demographics, procedural/periprocedural adverse events, and follow-up data, were collected. Results: Nine patients underwent direct TEN. Patients initially underwent CT-guided percutaneous drainage, with an average of 31 days between initial drainage and endoscopic necrosectomy. All patients had a technically successful placement of a fully covered esophageal metal stent through the cutaneous fistula. After a median of 3 endoscopic debridement sessions, 8 of 9 (89%) patients had successful removal of all percutaneous drains, and resolution of necrotic collections. One patient died of multisystem organ failure from severe acute pancreatitis. Conclusions: TEN for infected WON is a safe and efficacious technique for patients with endoscopically inaccessible collections.

AB - Background: Walled-off pancreatic necrosis (WON) is a sequelae of acute pancreatitis that requires debridement, once infected. Recently, endoscopic necrosectomy has become the mainstay for management. However, peripancreatic collections that extend to the paracolic gutter or lesser sac, are more challenging to treat endoscopically. We report an endoscopic method for management of necrotic collections that extend into the paracolic gutter. Methods: Consecutive patients, with symptomatic WON extending into the retroperitoneum, were included in a prospective registry. Each patient underwent transcutaneous endoscopic necrosectomy (TEN) through a fully covered self-expanding esophageal metal stent. After resolution of the collection, the external stent was removed, and the cutaneous fistula was allowed to close by secondary intention. Clinical success was defined as resolution of the WON, and successful removal of all percutaneous drains. Patient demographics, procedural/periprocedural adverse events, and follow-up data, were collected. Results: Nine patients underwent direct TEN. Patients initially underwent CT-guided percutaneous drainage, with an average of 31 days between initial drainage and endoscopic necrosectomy. All patients had a technically successful placement of a fully covered esophageal metal stent through the cutaneous fistula. After a median of 3 endoscopic debridement sessions, 8 of 9 (89%) patients had successful removal of all percutaneous drains, and resolution of necrotic collections. One patient died of multisystem organ failure from severe acute pancreatitis. Conclusions: TEN for infected WON is a safe and efficacious technique for patients with endoscopically inaccessible collections.

KW - endoscopic necrosectomy

KW - necrotizing pancreatitis

KW - walled-off pancreatic necrosis

UR - http://www.scopus.com/inward/record.url?scp=85023158446&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85023158446&partnerID=8YFLogxK

U2 - https://doi.org/10.1097/MCG.0000000000000895

DO - https://doi.org/10.1097/MCG.0000000000000895

M3 - Article

C2 - 28697152

VL - 52

SP - 458

EP - 463

JO - Journal of Clinical Gastroenterology

JF - Journal of Clinical Gastroenterology

SN - 0192-0790

IS - 5

ER -

Transcutaneous Endoscopic Necrosectomy for Walled-off Pancreatic Necrosis in the Paracolic Gutter

Abstract

ASJC Scopus subject areas

Keywords

Access to Document

Other files and links

Fingerprint

Cite this