Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series.
BACKGROUND
Direct endoscopic necrosectomy (DEN) for treatment of walled-off pancreatic necrosis (WOPN) has been performed as an alternative to operative or percutaneous therapy.


OBJECTIVE
To report the largest combined experience of DEN performed for WOPN.


METHODS
Retrospective chart review.


METHODS
Six U.S. tertiary medical centers.


METHODS
A total of 104 patients with a history of acute pancreatitis and symptomatic WOPN since 2003.


METHODS
DEN for WOPN.


METHODS
Resolution or near-resolution of WOPN without the need for surgical or percutaneous intervention and procedural complications.


RESULTS
Successful resolution was achieved in 95 of 104 patients (91%). Of the patients in whom it failed, 5 died during follow-up before resolution, 2 underwent operative drainage for persistent WOPN, 1 required surgery for massive bleeding on fistula tract dilation, and 1 died periprocedurally. The mean time to resolution from the initial DEN was 4.1 months. The first débridement was performed a mean of 63 days after the initial onset of acute pancreatitis. In 73%, the entry was transgastric with median tract dilation diameter of 18 mm. The median number of procedures was 3 with 2 débridements. Complications occurred in approximately 14% and included 5 retrogastric perforations/pneumoperitoneum, which were managed nonoperatively. Univariate analysis identified a body mass index >32 as a risk factor for failed DEN.


CONCLUSIONS
Retrospective, highly specialized centers.


CONCLUSIONS
This large, multicenter series demonstrates that transmural, minimally invasive endoscopic débridement of WOPN performed in the United States is an efficacious and reproducible technique with an acceptable safety profile.
Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Timothy B
TB
Gardner
Nayantara
N
Coelho-Prabhu
Stuart R
SR
Gordon
Andres
A
Gelrud
John T
JT
Maple
Georgios I
GI
Papachristou
Martin L
ML
Freeman
Mark D
MD
Topazian
Rajeev
R
Attam
Todd A
TA
Mackenzie
Todd H
TH
Baron
D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States