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Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases pp 379–390Cite as

Endoscopic Necrosectomy

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Abstract

Walled-off pancreatic necrosis (WON) arises as a complication of severe necrotizing pancreatitis. Direct endoscopic necrosectomy (DEN) is a feasible option when the following criteria are met: (1) presence of a mature wall, (2) endoscopically accessible, (3) significant liquefactive necrosis has occurred, (4) absence of significant coagulopathy, (5) absence of aneurysmal vessels within the WON, and (6) symptomatic. Access to the WON cavity is achieved under EUS guidance, after which the fistula is dilated to permit entry of a gastroscope for DEN. Clinical success rates of 75–91% have been reported. A pilot randomized trial showed that DEN reduced the pro-inflammatory response as well as the composite clinical end point of major complications compared with surgical necrosectomy. Although effective, there is a risk of significant morbidity and mortality. The extent and aggressiveness of DEN need to be individualized and weighed against the risks of complications.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore

    Tiing Leong Ang

  2. Center of Gastroenterology, Klinik Hirslanden, Witellikerstrasse 40, 8008, Zurich, Switzerland

    Stefan Seewald M.D.

Authors
  1. Tiing Leong Ang
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  2. Stefan Seewald M.D.
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Corresponding author

Correspondence to Stefan Seewald M.D. .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, School of Medicine, University of Tokai, Isehara, Kanagawa, Japan

    Tetsuya Mine

  2. Sankikai Medical Corporation, Yokohama, Kanagawa, Japan

    Rikiya Fujita

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© 2019 Springer Japan KK, part of Springer Nature

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Ang, T.L., Seewald, S. (2019). Endoscopic Necrosectomy. In: Mine, T., Fujita, R. (eds) Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases. Springer, Tokyo. https://doi.org/10.1007/978-4-431-56009-8_32

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  • DOI: https://doi.org/10.1007/978-4-431-56009-8_32

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  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-56007-4

  • Online ISBN: 978-4-431-56009-8

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