Interventions for walled off necrosis using an algorithm based endoscopic step-up approach: Outcomes in a large cohort of patients
| Autor: | Mustafa A. Arain, Gregory J. Beilman, Rajeev Attam, Guru Trikudanathan, Yukako Nemoto, Martin L. Freeman, Shawn Mallery |
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| Rok vydání: | 2016 |
| Předmět: |
Endoscopic ultrasound
Male medicine.medical_specialty Percutaneous Endocrinology Diabetes and Metabolism Psychological intervention Cohort Studies 03 medical and health sciences Necrosis 0302 clinical medicine medicine Humans Endoscopy Digestive System Adverse effect Aged Retrospective Studies Hepatology medicine.diagnostic_test business.industry Pancreatitis Acute Necrotizing Gastroenterology Middle Aged Large cohort Surgery Endoscopy Treatment Outcome 030220 oncology & carcinogenesis Walled off necrosis Transluminal approach Drainage 030211 gastroenterology & hepatology Female Radiology business Algorithm Algorithms |
| Zdroj: | Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]. 17(5) |
| ISSN: | 1424-3911 |
| Popis: | Objectives The minimally invasive step-up approach for treatment of walled off necrosis (WON) involves drainage followed by later necrosectomy as needed, and is superior to primary surgical necrosectomy. Reported series of endoscopic transluminal necrosectomy include highly selected patients. We report outcomes of a large series of patients with WON managed by an algorithm based on an endoscopically centered step-up approach. Methods Consecutive patients with necrotizing pancreatitis from 2009 to 2014, with intervention only for infected or persistently symptomatic WON. The primary approach involved endoscopic transluminal drainage plus minus necrosectomy whenever feasible, with percutaneous catheter drainage (PCD) plus minus sinus tract endoscopy if not feasible or sufficient. Surgery was reserved for failures of the step up approach. Results Of 109 consecutive patients with necrotizing pancreatitis, intervention was required in 83, including endoscopic transluminal drainage in 73 (88%) (alone in 49 and combined with PCD in 24), and PCD alone in 10 (12%). 64 (77%) of the 83 patients required endoscopic transluminal and/or sinus tract necrosectomy. Adverse events occurred in 11 (13%). Three patients (4%) failed step up approach and required open surgical necrosectomy. All-cause mortality occurred in 6 (7%) of 83 patients after intervention, including 2 of 3 requiring surgery. Conclusions An algorithm based step-up approach for interventions in necrotizing pancreatitis using primarily endoscopic techniques with adjunctive percutaneous approaches as needed resulted in favorable outcomes with small numbers proceeding to open surgery, and with acceptable rates of major complications and mortality. A purely endoscopic transluminal approach was feasible in approximately 60% of patients requiring intervention in this series. |
| Databáze: | OpenAIRE |
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