title: Pancreatic necrosectomy using covered esophageal stents: a novel approach.
abstract: BACKGROUND
  Endoscopic necrosectomy for necrotizing pancreatitis has been increasingly used as an alternative to surgical or percutaneous interventions. The use of fully covered esophageal self-expandable metallic stents may provide a safer and more efficient route for internal drainage. The aim of this study was to evaluate the safety and efficacy of endoscopic treatment of pancreatic necrosis with these stents.
  
  
  METHODS
  A retrospective study at 2 US academic hospitals included patients with infected pancreatic necrosis from July 2009 to November 2012. These patients underwent transgastric placement of fully covered esophageal metallic stents draining the necrosis. After necrosectomy, patients underwent regular sessions of endoscopic irrigation and debridement of cystic contents. The efficacy endpoint was successful resolution of infected pancreatic necrosis without the need for surgical or percutaneous interventions.
  
  
  RESULTS
  Seventeen patients were included with the mean age of 41±12 years. A mean of 5.3±3.4 sessions were required for complete drainage and the follow-up period was 237.6±165 days. Etiology included gallstone pancreatitis (6), alcohol abuse (6), s/p distal pancreatectomy (2), postendoscopic retrograde cholangiopancreatography pancreatitis (1), medication-induced pancreatitis (1), and hyperlipidemia (1). Mean size of the necrosis was 14.8 cm (SD 5.6 cm), ranging from 8 to 19 cm. Two patients failed endoscopic intervention and required surgery. The only complication was a perforation during tract dilation, which was managed conservatively. Fifteen patients (88%) achieved complete resolution.
  
  
  CONCLUSIONS
  Endoscopic necrosectomy with covered esophageal metal stents is a safe and successful treatment option for infected pancreatic necrosis.
authors.affiliation: *Division of Gastroenterology and Hepatology ‡Department of Surgery §Intensive Care Unit, Weil Cornell Medical College, Cornell University †Division of Gastroenterology and Hepatology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Savreet
authors.initials: S
authors.lastname: Sarkaria
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.forename: Carlos
authors.initials: C
authors.lastname: Rondon
authors.forename: Michael
authors.initials: M
authors.lastname: Lieberman
authors.forename: Indu
authors.initials: I
authors.lastname: Srinivasan
authors.forename: Kristen
authors.initials: K
authors.lastname: Weaver
authors.forename: Brian G
authors.initials: BG
authors.lastname: Turner
authors.forename: Subha
authors.initials: S
authors.lastname: Sundararajan
authors.forename: David
authors.initials: D
authors.lastname: Berlin
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.forename: Daniil
authors.initials: D
authors.lastname: Rolshud
authors.forename: Jessica
authors.initials: J
authors.lastname: Widmer
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000293:Adolescent; D000328:Adult; D003646:Debridement; D004322:Drainage / Q000379:methods; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D007507:Therapeutic Irrigation; D055815:Young Adult