title: Flexible percutaneous endoscopic retroperitoneal necrosectomy as rescue therapy for pancreatic necroses beyond the reach of endoscopic ultrasonography: A case series.
abstract: Minimally invasive or endoscopic transluminal drainage and necrosectomy are the standard of care for infected pancreatic fluid collections and necroses after pancreatitis. In an endoscopic treatment algorithm, necroses beyond the reach of safe endoscopic access are typically treated by percutaneous drainage. We aimed to evaluate percutaneous minimally invasive necrosectomy using a purely endoscopic technique in patients with extensive necrosis. In patients with necroses beyond safe transluminal reach, the percutaneous drainage canal was used for flexible endoscopic access and dilatation of the tract to 20 mm. Percutaneous endoscopic necrosectomy was carried out through this canal. We present a case series of 14 patients in whom between one and four necrosectomy (median two) sessions were done to remove solid necroses successfully in 13 out of 14 patients. There were no major complications apart from one patient with abdominal compartment syndrome secondary to delayed erosion of the splenic artery. Percutaneous flexible necrosectomy might evolve into an alternative to surgical minimally invasive necrosectomy in anatomical sites beyond transluminal endoscopic reach.
authors.affiliation: Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jürgensen
authors.affiliation: Medical Department 1, University Hospital Dresden, Technical University Dresden (TUD), Dresden, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Brückner
authors.affiliation: Department of Gastroenterology, Hepatology and General Internal Medicine, Wald-Klinikum General Hospital, Gera, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Reichel
authors.affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: Maik
authors.initials: M
authors.lastname: Kilian
authors.affiliation: Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Pannach
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Dresden, Technical University Dresden (TUD), Dresden, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Dresden, Technical University Dresden (TUD), Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.affiliation: Department of Gastroenterology, Endocrinology and Infectious Diseases, Klinikum Chemnitz GmbH, Chemnitz, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Neser
authors.affiliation: Medical Department 1, University Hospital Dresden, Technical University Dresden (TUD), Dresden, Germany.
authors.forename: Jochen
authors.identifier: http://orcid.org/0000-0002-2421-6127
authors.initials: J
authors.lastname: Hampe
authors.affiliation: Department of Gastroenterology, Hepatology and General Internal Medicine, Wald-Klinikum General Hospital, Gera, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Will
mesh_terms: D000368:Aged; D019723:Endoscopes; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D012187:Retroperitoneal Space; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: acute pancreatitis; necrosectomy; pancreatic necrosis; retroperitoneal necrosectomy; walled off necrosis (WON)