Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique.
Endoscopic management of walled-off pancreatic necrosis (WOPN) is an area of great interest with many still unanswered questions, including the role of mechanical necrosectomy versus irrigation. The aim of this study was to evaluate a new method of endoscopic transmural necrosectomy.



Patients with WOPN after necrotizing pancreatitis, who underwent endoscopic transmural necrosectomy using a lumen-apposing metal stent with vigorous irrigation sessions, were prospectively recruited between September 2011 and August 2014. Initial endoscopic session was performed by EUS-guided drainage and lavage sessions by flushing saline through the stent. Technical and clinical success rates, number of repeat interventions, and adverse events were analyzed.



Twelve patients with 13 WOPN collections (median size 12.4 ± 2.94 cm) underwent endoscopic treatment. Clinical success was achieved in 100 % of cases after a median of three sessions per patient (range 2-8). The median length of hospitalization was 15.9 days. Median procedure time of the access session was 31 ± 10.16 min. No adverse events (AE) were described during the procedures or 24 h after. There were four AE (two infections and two bleedings) between sessions, but only two were severe (16.6 %). There was no need for surgery, and no mortalities occurred. Mean time to stent retrieval was 9 ± 3.4 weeks. Mean follow-up was 13 months with only one recurrence at 12 months after stent removal.



This new variant of irrigation endoscopic transmural necrosectomy without mechanical debridement helps to simplify the technique, is feasible, and has excellent outcomes in WOPN treatment.
Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain. jgornals@bellvitgehospital.cat.
Joan B
JB
Gornals
Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain.
Claudia F
CF
Consiglieri
Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Juli
J
Busquets
Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain.
Silvia
S
Salord
Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain.
Meritxell
M
de-la-Hera
Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Lluis
L
Secanella
Department of Anesthesiology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Susana
S
Redondo
Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Nuria
N
Pelaez
Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Joan
J
Fabregat
D000328:Adult; D000368:Aged; D004322:Drainage; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D007507:Therapeutic Irrigation / Q000379:methods*
Endoscopic necrosectomy; Necrotizing pancreatitis; Self-expanding metal stent; Transmural drainage; Walled-off pancreatic necrosis