Non-fluoroscopic endoscopic ultrasound-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis.

Endoscopic treatment of pancreatic necrosis is less invasive than surgery but is a technically demanding procedure. The aim of the present study was to retrospectively evaluate the safety and efficacy of endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis (WOPN) without the use of fluoroscopy. Over the last 24 months, 20 patients (16 men) with symptomatic non-bulging WOPN were treated endoscopically at Department of Gastroenterology, PGIMER, Chandigarh, India.The WOPN was transmurally approached using a linear echoendoscope and the tract dilated over the wire and multiple stents and a nasocystic drain were placed. All 20 patients had acute severe pancreatitis and the etiology of pancreatitis was alcohol in 12, gallstones in six and idiopathic in two patients. All patients were symptomatic with pain and six patients had fever and presented 5 to 16 weeks after an acute episode.The size of WOPN ranged from 5 to 16 cm.All 20 patients had marked improvement with radiological resolution noted in 19 patients and only one patient required direct endoscopic necrosectomy. One patient with multiple WOPN had a large peripherally located WOPN that did not resolve after transmural drainage and required an additional percutaneous drainage. One to seven endoscopic sessions were required and all these patients had complete resolution within 6 weeks.There were no complications of the procedure.There has been no recurrence of symptoms in these patients over a median follow up of 14 months. EUS-guided transmural drainage of non-bulging WOPN without the use of fluoroscopy appears to be safe and effective.

Rana SS ，Bhasin DK ，Rao C ，Gupta R ，Singh K ... -  《-》

Endoscopic ultrasound-guided transmural drainage of walled-off pancreatic necrosis in patients with portal hypertension and intra-abdominal collaterals.

Rana SS ，Sharma R ，Ahmed SU ，Gupta R ... -  《-》

Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis.

Walled-off pancreatic necrosis often leads to severe clinical deterioration necessitating open debridement or endoscopic necrosectomy. A new EUS-based approach was devised to manage this condition by creating multiple transluminal gateways to facilitate effective drainage of the necrotic contents. To compare treatment outcomes between patients with walled-off pancreatic necrosis managed endoscopically by a multiple transluminal gateway technique (MTGT) or a conventional drainage technique (CDT). Retrospective study. Tertiary-care referral center. This study involved patients with severe acute pancreatitis complicated by walled-off pancreatic necrosis managed endoscopically. In MTGT, 2 or 3 transmural tracts were created by using EUS guidance between the necrotic cavity and the GI lumen. While one tract was used to flush normal saline solution via a nasocystic catheter, multiple stents were deployed in others to facilitate drainage of necrotic contents. In the CDT, two stents with a nasocystic catheter were deployed via 1 transmural tract. Resolution of symptoms, radiological findings on follow-up CT, and the need for subsequent surgery or endoscopic necrosectomy. Of 60 patients with symptomatic walled-off pancreatic necrosis, 12 (3 women, mean age 55.1 years) were managed by MTGT and 48 (12 women, mean age 55.2 years) by CDT. Treatment was successful in 11 of 12 (91.7%) patients managed by MTGT versus 25 of 48 (52.1%) managed by CDT (P = .01). Although 1 patient in the MTGT cohort required endoscopic necrosectomy, in the CDT cohort, 17 required surgery, 3 underwent endoscopic necrosectomy, and 3 died of multiple-organ failure. Treatment success was more likely for patients treated by MTGT than by CDT (adjusted odds ratio = 9.24; 95% confidence interval, 1.08-79.02; P = .04) when we adjusted for the size of the walled-off pancreatic necrosis and pancreatic duct stent placement. Selective patient population. The EUS-guided MTGT is an effective treatment option for the management of symptomatic walled-off pancreatic necrosis because it obviates the need for surgery and endoscopic necrosectomy and its attendant procedure-related morbidity. Prospective studies are required to confirm these preliminary but promising data.

Varadarajulu S ，Phadnis MA ，Christein JD ，Wilcox CM ... -  《-》

Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage of walled-off pancreatic necrosis (WOPN).

Jagielski M ，Smoczyński M ，Adrych K ，Sztuczka E ，Jackowski M ... -  《-》

The role of endoscopic ultrasonography in endoscopic debridement of walled-off pancreatic necrosis--A single center experience.

In recent years the significance of endoscopic ultrasonography (EUS) has increased. In our center we have also performed EUS-guided cystostomy since 2011. Earlier we had performed this procedure without EUS. Introduction of EUS in our hospital has inspired us to perform a retrospective analysis of the influence of EUS use on the risk of complications and the effectiveness of endoscopic treatment of patients with WOPN. Between years 2001 and 2013 176 patients with symptomatic WOPN underwent endoscopic treatment in the Department of Gastroenterology and Hepatology of Medical University of Gdańsk. The results and complications of treatment in relation to the use of EUS during drainage/debridement were compared retrospectively. 64 patients underwent EUS-guided drainage/debridement of WOPN (group 1). In the case of 112 patients endoscopic drainage/debridement was performed without EUS control (group 2). In group 1 therapeutic success was achieved in 60/64 (93.75%) patients in comparison to 104/112 (92.9%) patients in group 2 (P = 0.870). The mean duration of drainage/debridement in both groups was 25 days - 4-173 days in group 1 and 4-112 days in group 2 (P = 0.519). The complications of endotherapy occurred in 9/64 (14.06%) patients from group 1 in comparison to 29/112 (25.9%) patients from group 2 (P = 0.047). In our study the use of EUS during endoscopic drainage/debridement of WOPN significantly reduced the number of procedure-related complications, mainly gastrointestinal bleeding. However, it had no influence on the duration of treatment or the effectiveness of therapy.

Jagielski M ，Smoczyński M ，Jabłońska A ，Marek I ，Dubowik M ，Adrych K ... -  《-》