title: Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources.
abstract: OBJECTIVE
  Walled-off pancreatic necrosis (WOPN), a complication of severe acute pancreatitis (SAP), can become infected, obstruct adjacent structures, and result in clinical deterioration of patients. Patients with WOPN have prolonged hospitalizations, needing multiple radiologic and medical interventions. We compared an established treatment of WOPN, standard percutaneous drainage (SPD), with combined modality therapy (CMT), in which endoscopic transenteric stents were added to a regimen of percutaneous drains.
  
  
  METHODS
  Symptomatic patients with WOPN between January 2006 and August 2009 were treated with SPD (n = 43, 28 male) or CMT (n = 23, 17 male) and compared by disease severity, length of hospitalization, duration of drainage, complications, and number of radiologic and endoscopic procedures.
  
  
  RESULTS
  Patient age (59 vs 54 years), sex (77% vs 58% male), computed tomography severity index (8.0 vs 7.2), number of endoscopic retrograde cholangiopancreatographies (2.0 vs 2.6), and percentage with disconnected pancreatic ducts (50% vs 46%) were equivalent in the CMT and SPD arms, respectively. Patients undergoing CMT had significantly decreased length of hospitalization (26 vs 55 days, P < .0026), duration of external drainage (83.9 vs 189 days, P < .002), number of computed tomography scans (8.95 vs 14.3, P < .002), and drain studies (6.5 vs 13, P < .0001). Patients in the SPD arm had more complications.
  
  
  CONCLUSIONS
  For patients with symptomatic WOPN, CMT provided a more effective and safer management technique, resulting in shorter hospitalizations and fewer radiologic procedures than SPD.
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington 98101, USA. michael.gluck@vmmc.org
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
authors.forename: Andrew
authors.initials: A
authors.lastname: Ross
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.forename: Otto
authors.initials: O
authors.lastname: Lin
authors.forename: Ellen
authors.initials: E
authors.lastname: Hauptmann
authors.forename: Justin
authors.initials: J
authors.lastname: Siegal
authors.forename: Mehran
authors.initials: M
authors.lastname: Fotoohi
authors.forename: Robert
authors.initials: R
authors.lastname: Crane
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D011860:Radiography, Abdominal / Q000706:statistics & numerical data; D016896:Treatment Outcome