Combined endoscopic and percutaneous drainage of organized pancreatic necrosis.
BACKGROUND
Severe acute pancreatitis is often complicated by organized necrosis, which can lead to abscess formation and clinical deterioration. We sought to devise a combined endoscopic and percutaneous approach to drainage of organized pancreatic necrosis, with the primary goal of preventing the formation of chronic pancreaticocutaneous fistulae, and secondary goals of avoiding the need for surgical necrosectomy and reducing endoscopic resource utilization.


METHODS
Retrospective review of an institutional review board-approved database.


METHODS
Single North American tertiary referral center.


METHODS
Patients with severe acute pancreatitis complicated by organized necrosis requiring drainage.


METHODS
CT-guided percutaneous drain, followed immediately by endoscopic transenteric drainage.


METHODS
Development of chronic pancreaticocutaneous fistulae, number of endoscopic procedures requiring follow-up drainage, need for surgical necrosectomy, procedure-related morbidity, and mortality.


RESULTS
Fifteen patients (12 males, 3 females; mean age, 58 years) underwent combined modality drainage. All procedures were technically successful. Immediate complications included fever and hypotension (n = 2); late complications included parenchymal infection after drain removal (n = 1). Twenty-five total endoscopies (4 for drain manipulation) were performed in the cohort subsequent to the initial drainage. After a median duration of follow-up of 189 days, percutaneous drains were removed in all 13 patients in whom this was attempted; no patients had development of chronic pancreaticocutaneous fistulae. There were no deaths, and no patients required surgery.


CONCLUSIONS
Highly selected patient population, lack of comparison group, single-center experience.


CONCLUSIONS
In some highly selected patients with infected or symptomatic organized pancreatic necrosis, combined modality drainage results in favorable clinical outcomes with low associated, procedure-related morbidity. Pancreaticocutaneous fistulae and surgical necrosectomy were avoided with minimal endoscopic resource utilization.
Ross
Andrew
A
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Gluck
Michael
M
Irani
Shayan
S
Hauptmann
Ellen
E
Fotoohi
Mehran
M
Siegal
Justin
J
Robinson
David
D
Crane
Robert
R
Kozarek
Richard
R
D002760:Cholangiopancreatography, Endoscopic Retrograde; D003131:Combined Modality Therapy; D004322:Drainage; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed