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vol. 14
Letter to the Editor

Endoscopic necrosectomy through the major duodenal papilla under fluoroscopy imaging

Marian Smoczyński, Mateusz Jagielski, Magdalena Siepsiak, Krystian Adrych

Arch Med Sci 2018; 14, 2: 470–474
Online publish date: 2016/08/22
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In the last twenty years we have observed development of minimally invasive techniques of treatment of pancreatic necrosis [1, 2]. Those methods include procedures handled with the use of an endoscope, laparoscope or nephroscope, enabling a transperitoneal, retroperitoneal, transmural or transpapillary approach to necrotic collection [1, 2]. The choice of access to the necrosis depends on its location and spread.
A meta-analysis of 8 studies revealed that in 286 patients with infected pancreatic necrosis, percutaneous drainage, being the only way of access to the necrosis, was efficient in 44% of patients [3]. The average rates of complications and mortality related to treatment were respectively 28% and 20% [3]. The next meta-analysis of 11 studies involving 384 patients revealed that in over half of them percutaneous drainage was an efficient method of treatment [4].
In minimally invasive techniques of treatment of walled-off pancreatic necrosis (WOPN) by a retroperitoneal approach, an inflexible nephroscope or flexible endoscope is inserted into the cavity of the necrosis, and then necrotic tissues can be removed by different endoscopic instruments [5, 6]. The desired effect of treatment by a minimally invasive retroperitoneal approach was achieved in 75–93% of patients [5–11]. Complication were reported in 24–88% of patients and mortality in 0–25% of them [5–11].
Transmural endoscopic drainage of pancreatic necrosis is based on the removal of necrotic content through a stoma formed between the lumen of the gastrointestinal tract and the cavity of the necrotic collection [12]. It is possible to take advantage of transpapillary drainage in treatment of pancreatic necrosis when the main pancreatic duct is damaged [13]. Patients without clinical improvement despite applied endoscopic drainage require necrosectomy. Endoscopic treatment of WOPN is efficient in 81–91% of patients. Complications were observed in 14–26% of patients [14–17].
Laparoscopy is found to be the next technique of pancreatic necrosis treatment consisting in access to the necrosis by a transperitoneal approach. It is said to be the least commonly applied method of minimally invasive WOPN treatment and also the least described in the literature. Successful treatment of pancreatic necrosis by laparoscopic techniques was reported in 74–90% of patients with a complication rate of 13–48% and mortality of 0–11% [18–21].
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Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas 2012; 41: 1176-94.
Loveday BP, Petrov MS, Connor S, 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.
Bello B, Matthews JB. Minimally invasive treatment of pancreatic necrosis. World J Gastroenterol 2012; 18: 6829-35.
van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG, Gooszen HG. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011; 98: 18-27.
Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg 2000; 232: 175-80.
Connor S, Ghaneh P, Raraty M, et al. Minimally invasive retroperitoneal pancreatic necrosectomy. Dig Surg 2003; 20: 270-7.
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.
Horvath K, Freeny P, Escallon J, 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.
Connor S, Alexakis N, Raraty MG, et al. Early and late complications after pancreatic necrosectomy. Surgery 2005; 137: 499-505.
Horvath KD, Kao LS, Ali A, Wherry KL, Pellegrini CA, Sinanan MN. Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis. Surg Endosc 2001; 15: 677-82.
van van Santvoort HC, Besselink MG, Bollen TL, Buskens E, van Ramshorst B, Gooszen HG. Casematched comparison of the retroperitoneal approach with laparotomy for necrotizing pancreatitis. World J Surg. 2007; 31: 1635-42.
Baron TH, Kozarek RA. Endotherapy for organized pancreatic necrosis: perspectives after 20 years. Clin Gastroenterol Hepatol 2012; 10: 1202-7.
Baron TH. Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis. Tech Gastrointest Endosc 2004; 6: 91-9.
Smoczyński M, Marek I, Dubowik M, et al. Endoscopic drainage/debridement of walled-off pancreatic necrosis – single center experience of 112 cases. Pancreatology 2014; 14: 137-42.
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.
Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TH. Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 2007; 245: 943-51.
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.
Parekh D. Laparoscopic-assisted pancreatic necrosectomy: a new surgical option for treatment of severe necrotizing pancreatitis. Arch Surg 2006; 141: 895-902.
Wani SV, Patankar RV, Mathur SK. Minimally invasive approach to pancreatic necrosectomy. J Laparoendosc Adv Surg Tech A 2011; 21: 131-6.
Zhu JF, Fan XH, Zhang XH. Laparoscopic treatment of severe acute pancreatitis. Surg Endosc 2001; 15: 146-8.
Tan J, Tan H, Hu B, et al. Short-term outcomes from a multicenter retrospective study in China comparing laparoscopic and open surgery for the treatment of infected pancreatic necrosis. J Laparoendosc Adv Surg Tech A 2012; 22: 27-33.
Baron TH, Thaggard WG, Morgan DE, Stanley RJ. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996; 111: 755-64.
Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 2000; 356: 653-5.
Seewald S, Groth S, Omar S, 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.
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