title: Endoscopic therapy for infected pancreatic necrosis using fully covered self-expandable metal stents: combination of transluminal necrosectomy, transluminal and percutaneous drainage.
abstract: OBJECTIVE
  Endoscopic transluminal therapy has become the standard of care as a less invasive alternative to surgery. In a retrospective case series of two tertiary referral centers we report on an individualized concept combining EUS-guided drainage with self-expanding metal stents, direct transluminal debridement und percutaneous drainage.
  
  
  METHODS
  We treated 13 patients with infected pancreatic necrosis. Initially in all patients an EUS-guided drainage with plastic stents was performed under antibiotic protection (transduodenal: 2, transgastral: 11). After clinical consolidation (after 9.6 ± 9.4 days) a covered self-expanding metal stent (Niti-S, Taewoong medical Co., Seoul, Korea) was inserted by performing direct endoscopic necrosectomy in 2.9 ± 1.7 sessions through the stent. In cases of disrupted duct syndromes a pancreatic plastic stent was inserted (5 of 13 patients). In 5 of 13 cases additional percutaneous drainage was applied because of extended necrosis. In one patient percutaneous endoscopic drainage using the percutaneous access was needed.
  
  
  RESULTS
  A sustained clinical success was achieved in 12 of 13 cases (CRP before therapy 23.5 ± 14.4 mg/L, after 3.1 ± 2.6 mg/lL). Discharge occurred after 2.5 ± 22.4 days. The self-expanding metal stent was extracted after 82.5 ± 56.6 days. Mean follow up was 8.5 ± 5.9 months.
  
  
  CONCLUSIONS
  Our concept of combining transluminal drainage, direct endoscopic necrosectomy and percutaneuos drainage offers a safe and reliable alternative to surgery, even in case of extended necrosis.
authors.affiliation: Department of Gastroenterology, Elisabeth-Krankenhaus Essen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Albers
authors.affiliation: Department of Gastroenterology, Elisabeth-Krankenhaus Essen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Toermer
authors.affiliation: Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Charton
authors.affiliation: Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Neuhaus
authors.affiliation: Department of Gastroenterology, Elisabeth-Krankenhaus Essen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schumacher
mesh_terms: D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004724:Endoscopy / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy / Q000295:instrumentation* / Q000379:methods; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D008670:Metals