Advertisement

Direct Endoscopic Necrosectomy

  • Todd H. BaronEmail author
Chapter
  • 1.7k Downloads

Abstract

Over the last 20 years there have been refinements in the understanding and nomenclature of acute pancreatitis. Over a several week period following the onset of acute necrotizing pancreatitis, the necrosis becomes demarcated and organized. The term walled-off necrosis (WON) is now an accepted term. Endoscopic approaches have evolved from creation of small transmural tracts into the WON with irrigation to the creation of large transmural tracts, which allow flexible endoscopes to be advanced directly into the necrotic cavity to perform direct endoscopic necrosectomy (DEN). This chapter concentrates on DEN for WON.

Keywords

Acute Pancreatitis Pancreatic Necrosis Flexible Endoscope Gastric Outlet Obstruction Posterior Gastric Wall 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Bakker OJ, van Santvoort H, Besselink MG, Boermeester MA, van Eijck C, Dejong K, Dutch Pancreatitis Study Group, et al. Extrapancreatic necrosis without pancreatic parenchymal necrosis: a separate entity in necrotising pancreatitis? Gut. 2013;62(10):1475–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Acute Pancreatitis Classification Working Group, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Freeman ML, Werner J, van Santvoort HC, Baron TH, Besselink MG, Windsor JA, International Multidisciplinary Panel of Speakers and Moderators, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41(8):1176–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Easler JJ, Zureikat A, Papachristou GI. An update on minimally invasive therapies for pancreatic necrosis. Expert Rev Gastroenterol Hepatol. 2012;6(6):745–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Raraty MG, Halloran CM, Dodd S, Ghaneh P, Connor S, Evans J, et al. Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. Ann Surg. 2010;251:787–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Loveday BP, Petrov MS, Connor S, Rossaak JI, Mittal A, Phillips ARJ, et al. A comprehensive classification of invasive procedures for treating the local complications of acute pancreatitis based on visualization, route, and purpose. Pancreatology. 2011;11:406–13.PubMedCrossRefGoogle Scholar
  7. 7.
    Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, et al. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg. 2010;145:817–25.PubMedCrossRefGoogle Scholar
  8. 8.
    van Santvoort HC, Besselink MG, Bakker OJ, Sijbrand Hofker HS, Boermeester MA, Dejong CH, Dutch Pancreatitis Study Group, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362(16):1491–502.PubMedCrossRefGoogle Scholar
  9. 9.
    Baron TH, Kozarek RA. Endotherapy for organized pancreatic necrosis: perspectives after 20 years. Clin Gastroenterol Hepatol. 2012;10(11):1202–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Tarantino I, Traina M, Barresi L, Volpes R, Gridelli B. Transgastric plus transduodenal necrosectomy with temporary metal stents placement for treatment of large pancreatic necrosis. Pancreas. 2010;39(2):269–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Wehrmann T, Martchenko K, Riphaus A. Dual access endoscopic necrosectomy of infected pancreatic necrosis: a case report. Eur J Gastroenterol Hepatol. 2010;22(2):237–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Baron TH, Morgan DE, Vickers SM, Lazenby AJ. Organized pancreatic necrosis: endoscopic, radiologic, and pathologic features of a distinct clinical entity. Pancreas. 1999;19:105–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet. 2000;356:653–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Seewald S, Groth S, Omar S, Imazu H, Seitz U, deWeerth A, et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc. 2005;62:92–100.PubMedCrossRefGoogle Scholar
  15. 15.
    Gardner TB, Chahal P, Papachristou GI, Vege SS, Petersen BT, Gostout CJ, et al. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc. 2009;69:1085–94.PubMedCrossRefGoogle Scholar
  16. 16.
    Gardner TB, Coelho-Prabhu N, Gordon SR, Gelrud A, Maple JT, Papachristou GL, et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc. 2011;73:718–26.PubMedCrossRefGoogle Scholar
  17. 17.
    Jürgensen C, Arlt A, Neser F, Fritscher-Ravens A, Stölzel U, Hampe J. Endoscopic ultrasound criteria to predict the need for intervention in pancreatic necrosis. BMC Gastroenterol. 2012;12:48.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Voermans RP, Ponchon T, Schumacher B, Fumex F, Bergman JJ, Larghi A, et al. Forward-viewing versus oblique-viewing echoendoscopes in transluminal drainage of pancreatic fluid collections: a multicenter, randomized, controlled trial. Gastrointest Endosc. 2011;74(6):1285–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Kang SG, Park do H, Kwon TH, Park JY, Park SH, Park JH, et al. Transduodenal endoscopic necrosectomy via pancreaticoduodenal fistula for infected peripancreatic necrosis with left pararenal space extension (with videos). Gastrointest Endosc. 2008;67(2):380–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Belle S, Collet P, Post S, Kaehler G. Temporary cystogastrostomy with self-expanding metallic stents for pancreatic necrosis. Endoscopy. 2010;42:493–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Antillon MR, Bechtold ML, Bartalos CR, Marshall JB. Transgastric endoscopic necrosectomy with temporary metallic esophageal stent placement for the treatment of infected pancreatic necrosis (with video). Gastrointest Endosc. 2009;69(1):178–80.PubMedCrossRefGoogle Scholar
  22. 22.
    Sarkaria S, Sethi A, Rondon C, Lieberman M, Srinivasan I, Weaver K, et al. Pancreatic necrosectomy using covered esophageal stents: a novel approach. J Clin Gastroenterol. 2014;48(2):145–52.PubMedCrossRefGoogle Scholar
  23. 23.
    Itoi T, Nageshwar Reddy D, Yasuda I. New fully-covered self-expandable metal stent for endoscopic ultrasonography-guided intervention in infectious walled-off pancreatic necrosis (with video). J Hepatobiliary Pancreat Sci. 2013;20(3):403–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Krishnan A, Ramakrishnan R. EUS-guided endoscopic necrosectomy and temporary cystogastrostomy for infected pancreatic necrosis with self-expanding metallic stents. Surg Laparosc Endosc Percutan Tech. 2012;22(5):e319 21. doi: 10.1097/SLE.0b013e3182657e03. PubMed PMID: 23047418.PubMedCrossRefGoogle Scholar
  25. 25.
    Abdelhafez M, Elnegouly M, Hasab Allah MS, Elshazli M, Mikhail HM, Yosry A. Transluminal retroperitoneal endoscopic necrosectomy with the use of hydrogen peroxide and without external irrigation: a novel approach for the treatment of walled-off pancreatic necrosis. Surg Endosc. 2013;27(10):3911–20.PubMedCrossRefGoogle Scholar
  26. 26.
    Jürgensen C, Neser F, Boese-Landgraf J, Schuppan D, Stölzel U, Fritscher-Ravens A. Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary? Surg Endosc. 2012;26(5):1359–63.PubMedCrossRefGoogle Scholar
  27. 27.
    Coelho D, Ardengh JC, Eulálio JM, Manso JE, Mönkemüller K, Coelho JF. Management of infected and sterile pancreatic necrosis by programmed endoscopic necrosectomy. Dig Dis. 2008;26(4):364–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Navarrete C, Castillo C, Caracci M, Vargas P, Gobelet J, Robels I. Wide percutaneous access to pancreatic necrosis with self-expandable stent: new application (with video). Gastrointest Endosc. 2011;73:609–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Bakken JC, Baron TH. Pancreatic necrosectomy via percutaneous self-expandable metal stent placement. Gastrointest Endosc. 2011;73(4 Suppl):AB103.Google Scholar
  30. 30.
    Bakken JC, Baron TH. Use of partially covered and fully covered self expandable metal stents to establish percutaneous access for endoscopic necrosectomy. Endoscopy 2011;43(Suppl 1):A69.Google Scholar
  31. 31.
    Iwashita T, Lee JG, Nakai Y, Samarasena JB, Chang KJ. Successful management of arterial bleeding complicating endoscopic ultrasound-guided cystogastrostomy using a covered metallic stent. Endoscopy. 2012;44(Suppl 2 UCTN):E370-1.PubMedGoogle Scholar
  32. 32.
    Akbar A, Reddy DN, Baron TH. Placement of fully covered self-expandable metal stents to control entry-related bleeding during transmural drainage of pancreatic fluid collections (with video). Gastrointest Endosc. 2012;76(5):1060–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Baron TH, Wong Kee Song LM, Zielinski MD, Fotoohi M, Kozarek RA, Emura F. A comprehensive approach to the management of acute endoscopic perforations (with videos). Gastrointest Endosc. 2012;76(4):838–59.PubMedCrossRefGoogle Scholar
  34. 34.
    Iwashita T, Lee JG, Nakai Y, Samarasena JB, Park do H, Muthusamy VR, et al. Successful management of perforation during cystogastrostomy with an esophageal fully covered metallic stent placement. Gastrointest Endosc. 2012;76(1):214–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Seifert H, Biermer M, Schmitt W, Jürgensen C, Will U, Gerlach R, et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut. 2009;58(9):1260–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Voermans RP, Veldkamp MC, Rauws EA, Bruno MJ, Fockens P. Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc. 2007;66(5):909–16.PubMedCrossRefGoogle Scholar
  37. 37.
    Charnley RM, Lochan R, Gray H, O'Sullivan CB, Scott J, Oppong KE. Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy. 2006;38(9):925–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Barthet M, Ezzedine S. Transluminal endoscopic necrosectomy for pancreatic necrosis: in all hands and for all patients, or with selected endoscopists in selected patients? Gut. 2009;58(9):1180–2.PubMedCrossRefGoogle Scholar
  39. 39.
    Kozarek RA. Endoscopic management of pancreatic necrosis: not for the uncommitted. Gastrointest Endosc. 2005;62:101–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, Dutch Pancreatitis Study Group, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307:1053–61.PubMedCrossRefGoogle Scholar
  41. 41.
    Haghshenasskashani A, Laurence JM, Kwan V, Johnston E, Hollands MJ, Richardson AJ, et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc. 2011;25:3724–30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations