title: Single or multiport percutaneous endoscopic necrosectomy performed with the patient under conscious sedation is a safe and effective treatment for infected pancreatic necrosis (with video).
abstract: BACKGROUND
  Infected pancreatic necrosis (IPN) is a dreaded adverse event of acute pancreatitis (AP). Most patients with IPN require drainage and necrosectomy, preferably by a minimally invasive method.
  
  
  OBJECTIVE
  To study the success and safety of an alternative form of minimally invasive necrosectomy for IPN.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Tertiary care academic center.
  
  
  METHODS
  Consecutive patients with IPN formed the study group.
  
  
  METHODS
  Patients with IPN were initially treated conservatively including percutaneous drainage. Those who failed to improve underwent percutaneous endoscopic necrosectomy (PEN). Single- or multiport PEN was performed by using a flexible endoscope through the percutaneous tract. PEN involved vigorous lavage and suction followed by necrosectomy. Multiple sessions were undertaken depending on the size and number of collections and the amount of necrotic debris.
  
  
  METHODS
  Control of sepsis and resolution of collection(s) without the need for surgical necrosectomy.
  
  
  RESULTS
  During the period from October 2012 to July 2013, 165 patients (mean age, 38.82 ± 14.99 years; 119 male patients) were studied. Of them, 103 patients had necrotizing pancreatitis and IPN had developed in 74. Of these 74 patients with IPN, 15 underwent PEN after a mean interval of 39.2 days. Fourteen of the 15 patients improved after a mean of 5 sessions of PEN. Two of 15 patients had minor adverse events: self-limiting bleeding and pancreatic fistula in 1 patient each. One patient required surgery but died of organ failure.
  
  
  CONCLUSIONS
  Lack of a control arm.
  
  
  CONCLUSIONS
  PEN is a safe and effective minimally invasive technique for necrosectomy for IPN.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajan
authors.initials: R
authors.lastname: Dhingra
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Srivastava
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sanatan
authors.initials: S
authors.lastname: Behra
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Padmaprakash Kodavoor
authors.initials: PK
authors.lastname: Vadiraj
authors.affiliation: Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Venuthurimilli
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.lastname: Shalimar
authors.affiliation: Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nihar Ranjan
authors.initials: NR
authors.lastname: Dash
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Kumble Seetharama
authors.initials: KS
authors.lastname: Madhusudhan
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shivanand Ramachandra
authors.initials: SR
authors.lastname: Gamanagatti
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Garg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation; D003430:Cross-Sectional Studies; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult