title: Comparative evaluation of structural and functional changes in pancreas after endoscopic and surgical management of pancreatic necrosis.
abstract: BACKGROUND
  Patients with acute necrotizing pancreatitis may develop pancreatic insufficiency and this is commonly seen in patients who have undergone surgery for pancreatic necrosis. Owing to the paucity of relative data, we retrospectively evaluated the structural and functional changes in the pancreas after endoscopic and surgical management of pancreatic necrosis.
  
  
  METHODS
  The records of patients who underwent endoscopic transmural drainage of walled off pancreatic necrosis (WOPN) over the last 3 years and who completed at least 6 months of follow up were analyzed. Structural and functional changes in these patients were compared with 25 historical surgical controls (operated in 2005-2006).
  
  
  RESULTS
  Twenty six patients (21 M; mean age 35.4±8.1 years) who underwent endoscopic drainage for WOPN were followed up for 22.3±8.6 months. During the follow up, five (19.2%) patients developed diabetes with 3 patients requiring insulin and 1 patient with steatorrhea requiring pancreatic enzyme supplementation. The pancreatic fluid collection (PFC) recurred in 1 patient whose stents spontaneously migrated out. On follow up, in the surgery group, 2 (8%) patients developed steatorrhea and 11 (44%) developed diabetes. Five (20%) of these patients had recurrence of PFC. On comparison of follow up results of endoscopic drainage with surgery, recurrence rates as well as frequency of endocrine and exocrine insufficiency was lower in the endoscopic group but difference was not significant.
  
  
  CONCLUSIONS
  Structural and functional impairment of pancreas is seen less frequently in patients with pancreatic necrosis treated endoscopically compared to patients undergoing surgery, although the difference was insignificant. Further studies with large sample size are needed to confirm these initial results.
authors.affiliation: Department of Gastroenterology (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Ravi Sharma).
authors.forename: Surinder Singh
authors.initials: SS
authors.lastname: Rana
authors.affiliation: Department of Gastroenterology (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Ravi Sharma).
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Bhasin
authors.affiliation: Department of Gastroenterology (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Ravi Sharma).
authors.forename: Chalapathi
authors.initials: C
authors.lastname: Rao
authors.affiliation: Department of Gastroenterology (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Ravi Sharma).
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Surgery (Rajesh Gupta), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
keywords: Pancreatic necrosis; diabetes; pseudocyst; stent
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