Skip to main content
SpringerLink
Log in
Book cover

Diagnostic and Therapeutic Procedures in Gastroenterology pp 399–410Cite as

Endoscopic Management of Necrotizing Pancreatitis

  • Chapter
  • First Online:

  • 1775 Accesses

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Necrotizing pancreatitis is a potentially lethal disease and is associated with significant morbidity and consumes enormous healthcare resources. Over the last two decades, the treatment of necrotizing pancreatitis has significantly evolved from open surgery toward minimally invasive techniques, with endoscopic transmural drainage (ETD) and necrosectomy emerging as principle forms of treatment. The majority of patients with necrotizing pancreatitis have sterile necrosis, which can be successfully treated conservatively. Patients with infected necrosis generally need to undergo an intervention which should ideally be delayed as long as possible, preferably 4 weeks or longer after the onset of disease, for better demarcation and liquefaction of the necrosis. Endoscopic treatment is most indicated in patients with well-encapsulated pancreatic or peripancreatic collections of fluid or necrotic debris with signs of infection and clinical deterioration, luminal or biliary obstruction, or severe pain. This review provides an overview of current status, technique, and recent innovations of endoscopic treatment of necrotizing pancreatitis.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Sarles H. Revised classification of pancreatitis--Marseille 1984. Dig Dis Sci. 1985;30:573–4.

    Article  CAS  PubMed  Google Scholar 

  2. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400.

    Article  PubMed  Google Scholar 

  3. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.

    Article  PubMed  Google Scholar 

  4. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141:1254–63.

    Article  PubMed  Google Scholar 

  5. Isenmann R, Buchler M, Uhl W, et al. Pancreatic necrosis: an early finding in severe acute pancreatitis. Pancreas. 1993;8:358–61.

    Article  CAS  PubMed  Google Scholar 

  6. Sakorafas GH, Tsiotos GG, Sarr MG. Extrapancreatic necrotizing pancreatitis with viable pancreas: a previously under-appreciated entity. J Am Coll Surg. 1999;188:643–8.

    Article  CAS  PubMed  Google Scholar 

  7. Shyu JY, Sainani NI, Sahni VA, et al. Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics Rev Publ Radiol Soc North Am Inc. 2014;34:1218–39.

    Google Scholar 

  8. Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262:751–64.

    Article  PubMed  Google Scholar 

  9. Beger HG, Bittner R, Block S, et al. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology. 1986;91:433–8.

    Article  CAS  PubMed  Google Scholar 

  10. Tenner S, Sica G, Hughes M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology. 1997;113:899–903.

    Article  CAS  PubMed  Google Scholar 

  11. Uhl W, Warshaw A, Imrie C, et al. IAP guidelines for the surgical Management of Acute Pancreatitis. Pancreatology Off J Int Assoc Pancreatol (IAP) [et al]. 2002;2:565–73.

    Article  Google Scholar 

  12. Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg. 1999;86:1020–4.

    Article  CAS  PubMed  Google Scholar 

  13. Buchler MW, Gloor B, Muller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000;232:619–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Anand N, Park JH, Wu BU. Modern management of acute pancreatitis. Gastroenterol Clin N Am. 2012;41:1–8.

    Article  Google Scholar 

  15. Lenhart DK, Balthazar EJ. MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections. AJR Am J Roentgenol. 2008;190:643–9.

    Article  PubMed  Google Scholar 

  16. Takahashi N, Papachristou GI, Schmit GD, et al. CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur Radiol. 2008;18:2522–9.

    Article  PubMed  Google Scholar 

  17. Banks PA, Gerzof SG, Langevin RE, et al. CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome. Int J Pancreatol Off J Int Assoc Pancreatol. 1995;18:265–70.

    CAS  Google Scholar 

  18. Fernandez-del Castillo C, Rattner DW, Makary MA, et al. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg. 1998;228:676–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Rau B, Pralle U, Mayer JM, et al. Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis. Br J Surg. 1998;85:179–84.

    Article  CAS  PubMed  Google Scholar 

  20. Anonymous. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology Off J Int Assoc Pancreatol (IAP) [et al]. 2013;13:e1–15.

    Article  Google Scholar 

  21. Traverso LW, Kozarek RA. Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg Off J Soc Surgery Alimentary Tract. 2005;9:436–9.

    Article  Google Scholar 

  22. Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400–15. 1416.

    Article  CAS  PubMed  Google Scholar 

  23. Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg. 2008;247:294–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Raraty MG, Halloran CM, Dodd S, et al. Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. Ann Surg. 2010;251:787–93.

    Article  PubMed  Google Scholar 

  25. Mier J, Leon EL, Castillo A, et al. Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg. 1997;173:71–5.

    Article  CAS  PubMed  Google Scholar 

  26. Bugiantella W, Rondelli F, Boni M, et al. Necrotizing pancreatitis: a review of the interventions. Int J Surg (London, England). 2015; doi:10.1016/j.ijsu.2015.12.038.

  27. Besselink MG, Verwer TJ, Schoenmaeckers EJ, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg (Chicago, Ill 1960). 2007;142:1194–201.

    Article  Google Scholar 

  28. Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41:1176–94.

    Article  PubMed  Google Scholar 

  29. Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007;132:2022–44.

    Article  CAS  PubMed  Google Scholar 

  30. Ruiz-Clavijo D, de la Higuera BG, Vila JJ. Advances in the endoscopic management of pancreatic collections. World J Gastrointest Endosc. 2015;7:381–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sriram PV, Kaffes AJ, Rao GV, et al. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts complicated by portal hypertension or by intervening vessels. Endoscopy. 2005;37:231–5.

    Article  CAS  PubMed  Google Scholar 

  32. Antillon MR, Shah RJ, Stiegmann G, et al. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest Endosc. 2006;63:797–803.

    Article  PubMed  Google Scholar 

  33. Voermans RP, Veldkamp MC, Rauws EA, et al. Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc. 2007;66:909–16.

    Article  PubMed  Google Scholar 

  34. Vilmann AS, Menachery J, Tang SJ, et al. Endosonography guided management of pancreatic fluid collections. World J Gastroenterol WJG. 2015;21:11842–53.

    Article  PubMed  Google Scholar 

  35. Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc. 2008;68:1102–11.

    Article  PubMed  Google Scholar 

  36. Park DH, Lee SS, Moon SH, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy. 2009;41:842–8.

    Article  CAS  PubMed  Google Scholar 

  37. Gardner TB, Chahal P, Papachristou GI, 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.

    Article  PubMed  Google Scholar 

  38. Gardner TB. Endoscopic management of necrotizing pancreatitis. Gastrointest Endosc. 2012;76:1214–23.

    Article  PubMed  Google Scholar 

  39. Hookey LC, Debroux S, Delhaye M, et al. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc. 2006;63:635–43.

    Article  PubMed  Google Scholar 

  40. Seewald S, Thonke F, Ang TL, et al. One-step, simultaneous double-wire technique facilitates pancreatic pseudocyst and abscess drainage (with videos). Gastrointest Endosc. 2006;64:805–8.

    Article  PubMed  Google Scholar 

  41. Baron TH. Endoscopic drainage of pancreatic pseudocysts. J Gastrointest Surg Off J Soc Surg Alimentary Tract. 2008;12:369–72.

    Article  Google Scholar 

  42. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44:784–800.

    Article  PubMed  Google Scholar 

  43. Varadarajulu S, Rana SS, Bhasin DK. Endoscopic therapy for pancreatic duct leaks and disruptions. Gastrointest Endosc Clin N Am. 2013;23:863–92.

    Article  PubMed  Google Scholar 

  44. Neoptolemos JP, London NJ, Carr-Locke DL. Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis. Br J Surg. 1993;80:94–9.

    Article  CAS  PubMed  Google Scholar 

  45. Lau ST, Simchuk EJ, Kozarek RA, et al. A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis. Am J Surg. 2001;181:411–5.

    Article  CAS  PubMed  Google Scholar 

  46. Howard TJ, Moore SA, Saxena R, et al. Pancreatic duct strictures are a common cause of recurrent pancreatitis after successful management of pancreatic necrosis. Surgery. 2004;136:909–16.

    Article  PubMed  Google Scholar 

  47. Trikudanathan G, Attam R, Arain MA, et al. Endoscopic interventions for necrotizing pancreatitis. Am J Gastroenterol. 2014;109:969–81. quiz 982

    Article  PubMed  Google Scholar 

  48. Bakker OJ, van Baal MC, van Santvoort HC, et al. Endoscopic transpapillary stenting or conservative treatment for pancreatic fistulas in necrotizing pancreatitis: multicenter series and literature review. Ann Surg. 2011;253:961–7.

    Article  PubMed  Google Scholar 

  49. Nadkarni NA, Kotwal V, Sarr MG, et al. Disconnected pancreatic duct syndrome: endoscopic stent or Surgeon's knife? Pancreas. 2015;44:16–22.

    Article  PubMed  Google Scholar 

  50. Fisher JM, Gardner TB. Endoscopic therapy of necrotizing pancreatitis and pseudocysts. Gastrointest Endosc Clin N Am. 2013;23:787–802.

    Article  PubMed  Google Scholar 

  51. Arvanitakis M, Delhaye M, Bali MA, et al. Endoscopic treatment of external pancreatic fistulas: when draining the main pancreatic duct is not enough. Am J Gastroenterol. 2007;102:516–24.

    Article  PubMed  Google Scholar 

  52. Arvanitakis M, Delhaye M, Bali MA, et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc. 2007;65:609–19.

    Article  PubMed  Google Scholar 

  53. Varadarajulu S, Wilcox CM. Endoscopic placement of permanent indwelling transmural stents in disconnected pancreatic duct syndrome: does benefit outweigh the risks? Gastrointest Endosc. 2011;74:1408–12.

    Article  PubMed  Google Scholar 

  54. Rana SS, Bhasin DK, Rao C, et al. Consequences of long term indwelling transmural stents in patients with walled off pancreatic necrosis & disconnected pancreatic duct syndrome. Pancreatology Off J Int Assoc Pancreatol (IAP) [et al]. 2013;13:486–90.

    Article  Google Scholar 

  55. Kawakami H, Itoi T, Sakamoto N. Endoscopic ultrasound-guided transluminal drainage for peripancreatic fluid collections: where are we now? Gut Liver. 2014;8:341–55.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Walter D, Will U, Sanchez-Yague A, et al. A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a prospective cohort study. Endoscopy. 2015;47:63–7.

    Article  PubMed  Google Scholar 

  57. Gornals JB, De la Serna-Higuera C, Sanchez-Yague A, et al. Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg Endosc. 2013;27:1428–34.

    Article  PubMed  Google Scholar 

  58. Sharaiha RZ, DeFilippis EM, Kedia P, et al. Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc. 2015;82:822–7.

    Article  PubMed  Google Scholar 

  59. Bang JY, Hawes R, Bartolucci A, et al. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: a systematic review. Dig Endosc Off J Japan Gastroenterol Endosc Soc. 2015;27:486–98.

    Google Scholar 

  60. van Brunschot S, Fockens P, Bakker OJ, et al. Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. Surg Endosc. 2014;28:1425–38.

    Article  PubMed  Google Scholar 

  61. Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307:1053–61.

    Article  CAS  PubMed  Google Scholar 

  62. Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010;375:475–80.

    Article  PubMed  Google Scholar 

  63. Baron TH, Harewood GC, Morgan DE, et al. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc. 2002;56:7–17.

    Article  PubMed  Google Scholar 

  64. Varadarajulu S, Tamhane A, Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video). Gastrointest Endosc. 2008;68:656–66.

    Article  PubMed  Google Scholar 

  65. Binmoeller KF, Soehendra N. Endoscopic ultrasonography in the diagnosis and treatment of pancreatic pseudocysts. Gastrointest Endosc Clin N Am. 1995;5:805–16.

    CAS  PubMed  Google Scholar 

  66. Fabbri C, Luigiano C, Maimone A, et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections. World J Gastrointest Endosc. 2012;4:479–88.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Voermans RP, Besselink MG, Fockens P. Endoscopic management of walled-off pancreatic necrosis. J Hepatobiliary Pancreat Sci. 2015;22:20–6.

    Article  PubMed  Google Scholar 

  68. Haghshenasskashani A, Laurence JM, Kwan V, et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc. 2011;25:3724–30.

    Article  PubMed  Google Scholar 

  69. Gardner TB, Coelho-Prabhu N, Gordon SR, 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.

    Article  PubMed  Google Scholar 

  70. Bang JY, Wilcox CM, Trevino J, et al. Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis. J Gastroenterol Hepatol. 2013;28:1725–32.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Varadarajulu S, Christein JD, Wilcox CM. Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients. J Gastroenterol Hepatol. 2011;26:1504–8.

    Article  PubMed  Google Scholar 

  72. Talreja JP, Shami VM, Ku J, et al. Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents (with video). Gastrointest Endosc. 2008;68:1199–203.

    Article  PubMed  Google Scholar 

  73. Donepudi S, Chavalitdhamrong D, Pu L, et al. Air embolism complicating gastrointestinal endoscopy: a systematic review. World J Gastrointest Endosc. 2013;5:359–65.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Seifert H, Biermer M, Schmitt W, et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD study). Gut. 2009;58:1260–6.

    Article  CAS  PubMed  Google Scholar 

  75. Yasuda I, Nakashima M, Iwai T, et al. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: the JENIPaN study. Endoscopy. 2013;45:627–34.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea

    Dongwook Oh

  2. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88-Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea

    Dong-Wan Seo

Authors
  1. Dongwook Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong-Wan Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dong-Wan Seo .

Editor information

Editors and Affiliations

  1. Advanced Endoscopy, Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    Subbaramiah Sridhar

  2. Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA

    George Y. Wu

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Oh, D., Seo, DW. (2018). Endoscopic Management of Necrotizing Pancreatitis. In: Sridhar, S., Wu, G. (eds) Diagnostic and Therapeutic Procedures in Gastroenterology. Clinical Gastroenterology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62993-3_32

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62993-3_32

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-62991-9

  • Online ISBN: 978-3-319-62993-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation