EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis.
BACKGROUND
Infected pancreatic and peripancreatic necrosis in acute pancreatitis is potentially lethal, with mortality rates up to 35%. Therefore, there is growing interest in minimally invasive treatment options, such as (EUS-guided) endoscopic transgastric necrosectomy.


METHODS
Retrospective cohort study on EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis.


RESULTS
8 patients (age 38-75, mean 50 years) with documented infected peripancreatic or pancreatic necrosis were included. Median time to first intervention was 33 days (range 17-62) after onset of symptoms. At the time of first intervention 2 patients had organ failure. All patients were managed on the patient ward. Initial endoscopic drainage was successful in all patients, a median of 4 (range 2-6) subsequent endoscopic necrosectomies were needed to remove all necrotic tissue. Two patients needed additional surgical intervention because of pneumoperitoneum (n = 1) and insufficient endoscopic drainage (n = 1). Six patients recovered, with 1 mild relapse during follow-up (median 12, range 8-60 months). One patient died.


CONCLUSIONS
EUS-guided endoscopic transgastric necrosectomy of infected necrosis in acute pancreatitis appears to be a feasible and relatively safe treatment option in patients who are not critically ill. Further randomized comparison with the current 'gold standard' is warranted to determine the place of this treatment modality.
Schrover
Ilse M
IM
Department of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands.
Weusten
Bas L A M
BL
Besselink
Marc G H
MG
Bollen
Thomas L
TL
van Ramshorst
Bert
B
Timmer
Robin
R
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography