title: Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary?
abstract: BACKGROUND
  Findings have shown endoscopic necrosectomy to be beneficial for patients with symptomatic pancreatic necrosis accessible for an endoscopic approach. The available studies show that endoscopic necrosectomy requires a multitude of subsequent procedures including repeat irrigation for removal of the necrotic material. This study aimed to investigate the need for additional irrigation in patients with necrotizing pancreatitis treated by endoscopic necrosectomy.
  
  
  METHODS
  The study enrolled 35 consecutive patients (27 men) with a median age of 59 years who had pancreatic necrosis treated with endoscopic necrosectomy. Endoscopic ultrasound-guided internal drainage and consecutive endoscopic necrosectomy was combined with interval multistenting of the cavity. Neither endoscopic nor external irrigation was part of the procedure.
  
  
  RESULTS
  An average of 6.2 endoscopy sessions per patient were needed for access, necrosectomy, and stent management. The in-hospital mortality rate was 6% (2/35), including one procedure-related death resulting from postinterventional aspiration. The immediate morbidity rate was 9% (3/35). It was possible to achieve clinical remission for all the surviving patients with no additional surgery needed for management of the necroses. The median follow-up period was 23 months.
  
  
  CONCLUSIONS
  Neither endoscopic nor external flushing is needed for successful endoscopic treatment of symptomatic necroses. Even without irrigation, the outcome for patients treated with endoscopic necrosectomy is comparable to that described in the published data.
authors.affiliation: Department of Gastroenterology, Rheumatology and Infectious Diseases, Charité University Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany. Christian.Juergensen@charite.de
authors.forename: Christian
authors.initials: C
authors.lastname: Jürgensen
authors.forename: Frank
authors.initials: F
authors.lastname: Neser
authors.forename: Joachim
authors.initials: J
authors.lastname: Boese-Landgraf
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stölzel
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010195:Pancreatitis / Q000601:surgery*; D015607:Stents; D007507:Therapeutic Irrigation; D018084:Ultrasonography, Interventional; D055815:Young Adult
references.citation: Lancet. 2000 Aug 19;356(9230):653-5
references.pmid: 10968442
references.citation: Br J Surg. 2006 May;93(5):593-9
references.pmid: 16521173
references.citation: Pancreatology. 2008;8(3):271-6
references.pmid: 18497540
references.citation: Dig Dis. 2008;26(4):364-9
references.pmid: 19188729
references.citation: Gastroenterology. 1996 Sep;111(3):755-64
references.pmid: 8780582
references.citation: Endoscopy. 2006 Sep;38(9):925-8
references.pmid: 16981111
references.citation: Surg Endosc. 1990;4(4):227-9
references.pmid: 2291166
references.citation: Gut. 2009 Sep;58(9):1260-6
references.pmid: 19282306
references.citation: Ann Surg. 2007 Jun;245(6):943-51
references.pmid: 17522520
references.citation: Z Gastroenterol. 2008 Dec;46(12):1363-8
references.pmid: 19053004
references.citation: Ann Surg. 2008 Dec;248(6):1074-80
references.pmid: 19092353
references.citation: Gastrointest Endosc. 2009 May;69(6):1085-94
references.pmid: 19243764
references.citation: Gastrointest Endosc. 2007 Nov;66(5):909-16
references.pmid: 17963877
references.citation: Gastrointest Endosc. 2005 Jul;62(1):92-100
references.pmid: 15990825
references.citation: Gastrointest Endosc. 2009 Jan;69(1):178-80
references.pmid: 18582877
references.citation: Surgery. 2005 May;137(5):499-505
references.pmid: 15855920
references.citation: Surgery. 2005 Jul;138(1):28-39
references.pmid: 16003313