Robert Wood Johnson Medical School, Rutgers University New Brunswick, NJ, United States
Abhishek A. Chouthai, MD, Mihajlo Gjeorgjievski, MD, Abhishek Bhurwal, MD, Abdelhai Abdelqader, MD, Monica Gaidhane, MPH, ACRP-CP, Avik Sarkar, MD, Haroon Shahid, MD, Amy Tyberg, MD, Michel Kahaleh, MD Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
Introduction: While necrotizing pancreatitis has greater morbidity and mortality than acute pancreatitis, infected pancreatic necrosis increases mortality rate up to 30%; therefore early identification and initiation of therapy is necessary. Infected/persistently symptomatic acute necrotic collection and walled off necrosis require further treatment with drainage. Solely endoscopic transluminal drainage is feasible in less than 2/3 of patients, while the rest require the addition of percutaneous drainage (PCD) or surgery. Percutaneous endoscopic necrosectomy (PEN) is an adjunct to PCD, where a flexible endoscope is inserted percutaneously for debridement of solid necrosis, leading to resolution of sepsis. We aimed to present the outcomes of 7 patients with necrotizing pancreatitis treated with PEN in our center.
Methods: Retrospective chart review was conducted for 7 patients with necrotizing pancreatitis who had undergone PEN. The primary outcome was defined as complete resolution of necrosis and removal of drainage catheters/stents. The secondary outcomes were periprocedural morbidity, long-term morbidity, and long-term mortality.
Results: The avg. PEN candidate was 45yo. The etiology of pancreatitis varied: 3 biliary, 2 alcohol, 1 ERCP mediated, and 1 triglyceride, with12.6cm avg. size of necrosis. An avg. of 5.8 PEN sessions/patient were completed prior to resolution with an avg. procedure time of 37 minutes utilizing therapeutic, 3.7mm channel flexible endoscope (1T). The average long-term follow-up time was 6.8mo.. Necrosis was completely eradicated in 6/7 patients (85.7%) with removal of drainage catheters/stents in an avg. of 35 days. There was no periprocedural morbidity/long-term mortality, however there was long-term morbidity in 1/7 patients (14.2%) secondary to bleeding. It is of note, no patients required subsequent videoscopic assisted retroperitoneal debridement or open necrosectomy.
Discussion: Based on our results, PEN represents a safe approach of treating pancreatic necrosis with difficult to reach transluminal endoscopic drainage and necrosectomy. The long-term morbidity of 14.2% and 0% mortality of PEN is lower than the previously reported morbidity and mortality of surgically managed necrotizing pancreatitis with morbidity of (34–95%) and mortality (11–39%) rates. In conclusion, PEN is a minimally invasive endoscopic therapy for walled-off pancreatic necrosis, which proves to be a safe and effective modality in treating necrosis not easily accessible by transluminal approach.
Figure: Conversion of percutaneous drain and placement of covered metal stent as an entry for further endoscopic necrosectomy.
Abhishek Chouthai indicated no relevant financial relationships.
Mihajlo Gjeorgjievski indicated no relevant financial relationships.
Abhishek Bhurwal indicated no relevant financial relationships.
Abdelhai Abdelqader indicated no relevant financial relationships.
Monica Gaidhane indicated no relevant financial relationships.
Avik Sarkar indicated no relevant financial relationships.
Haroon Shahid indicated no relevant financial relationships.
Amy Tyberg indicated no relevant financial relationships.
Michel Kahaleh indicated no relevant financial relationships.
Abhishek A. Chouthai, MD, Mihajlo Gjeorgjievski, MD, Abhishek Bhurwal, MD, Abdelhai Abdelqader, MD, Monica Gaidhane, MPH, ACRP-CP, Avik Sarkar, MD, Haroon Shahid, MD, Amy Tyberg, MD, Michel Kahaleh, MD. P0631 - Percutaneous Endoscopic Necrosectomy - A Single Center Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.