title: Non-fluoroscopic endoscopic ultrasound-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis.
abstract: OBJECTIVE
  Endoscopic treatment of pancreatic necrosis is less invasive than surgery but is a technically demanding procedure. The aim of the present study was to retrospectively evaluate the safety and efficacy of endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis (WOPN) without the use of fluoroscopy.
  
  
  METHODS
  Over the last 24 months, 20 patients (16 men) with symptomatic non-bulging WOPN were treated endoscopically at Department of Gastroenterology, PGIMER, Chandigarh, India.The WOPN was transmurally approached using a linear echoendoscope and the tract dilated over the wire and multiple stents and a nasocystic drain were placed.
  
  
  RESULTS
  All 20 patients had acute severe pancreatitis and the etiology of pancreatitis was alcohol in 12, gallstones in six and idiopathic in two patients. All patients were symptomatic with pain and six patients had fever and presented 5 to 16 weeks after an acute episode.The size of WOPN ranged from 5 to 16 cm.All 20 patients had marked improvement with radiological resolution noted in 19 patients and only one patient required direct endoscopic necrosectomy. One patient with multiple WOPN had a large peripherally located WOPN that did not resolve after transmural drainage and required an additional percutaneous drainage. One to seven endoscopic sessions were required and all these patients had complete resolution within 6 weeks.There were no complications of the procedure.There has been no recurrence of symptoms in these patients over a median follow up of 14 months.
  
  
  CONCLUSIONS
  EUS-guided transmural drainage of non-bulging WOPN without the use of fluoroscopy appears to be safe and effective.
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. drsurinderrana@yahoo.co.in
authors.forename: Surinder Singh
authors.initials: SS
authors.lastname: Rana
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Bhasin
authors.forename: Chalapathi
authors.initials: C
authors.lastname: Rao
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D004322:Drainage / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional