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 journalArticlepeer-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 languageEnglish (US)
Pages (from-to)458-463
Number of pages6
JournalJournal of Clinical Gastroenterology
Volume52
Issue number5
DOIs
StatePublished - 2018
Externally publishedYes

ASJC Scopus subject areas

  • Gastroenterology

Keywords

  • endoscopic necrosectomy
  • necrotizing pancreatitis
  • walled-off pancreatic necrosis

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