The role of endoscopic ultrasonography in transmural drainage/debridement of walled-off pancreatic necrosis

In numerous publications it has been proved that application of endoscopic ultrasonography (EUS) in transmural drainage of pancreatic fluid collections (PFCs) increases the efficiency and safety of treatment [1–3]. In our article “The role of endoscopic ultrasonography in endoscopic drainage/debridement of walled-off pancreatic necrosis – a single-center experience” published in 2015 in “Pancreatology” we compared two groups of patients with symptomatic walled-off pancreatic necrosis (WOPN) treated endoscopically with and without the use of EUS in our medical center between 2001 and 2013 [4]. In the mentioned article the group of patients treated with the use of EUS (conventional drainage) until 2011 consisted of 112 people, while the number of patients treated endoscopically with EUS from the time of introduction of EUS in our hospital in 2011 until 2013 was 64. As a result of comparison of the two groups we demonstrated that the use of endoscopic ultrasonography during endoscopic drainage/debridement of WOPN significantly reduces the number of procedure-related complications. However, it has no influence on the duration of treatment or the efficiency of therapy. In the time being (2017) the number of patients who have been treated with EUS-guided drainage/debridement of WOPN in our department since 2011 is 114. The increased number of patients treated endoscopically with the use of EUS inspired us to share our observations. Endoscopic ultrasonography allows one to identify solid debris in the lumen of the pancreatic collection, which enables one to distinguish WOPN from other pancreatic fluid collections. What is more, EUS-guided drainage/debridement of WOPN not only facilitates the choice of fistula site, but also allows drainage of necrotic collections regardless of their location (particularly in the absence of an endoscopically defined area of extrinsic compression). The application of endoscopic ultrasonography in drainage/debridement of walled-off pancreatic necrosis significantly reduces the number of procedure-related complications, especially gastrointestinal bleeding. Thereby it increases the safety of treatment, which was described in our article. All the above-mentioned advantages of EUS in the treatment of patients with pancreatic necrosis make it extremely useful for transmural drainage/debridement of WOPN. However, EUS also has disadvantages such as technical failures. Under endoscopic view during the conventional drainage we are able...


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