Direct Endoscopic Necrosectomy of Walled-off Pancreatic Necrosis: Single Center Experience

Abstract

Purpose: Background: Walled-off pancreatic necrosis (WOPN) is known complication of acute or chronic pancreatitis. Ongoing abdominal pain, suspicion of infected necrosis (fever, leukocytosis, etc.), and gastric outlet obstruction are indications for necrosectomy. The traditional approach to treatment was open surgical necrosectomy. In the literature Surgery carries a high morbidity and mortality ranging from 12%-56%. Objective: We are looking at our single center experience with direct endoscopic necrosectomy. Methods: Nonrandomized observational study was conducted using chart review by searching our endoscopy database at UMass Memorial Medical center between December 2010 and April 2012. Primary outcome is resolution of collection without need for operative or percutaneous intervention. Results: 8 consecutive patients with WOPN were treated with direct endoscopic necrosectomy (DEN). Clinical characteristics are described in Table 1. Mean age was 48.62; seven patients were males and one female. 50% of WOPN were as a result of gallstone pancreatitis. Infected necrosis was present in 87.5% of WOPN. Average WBC before intervention was 9.5 th/mm3 with average albumin of 2.51 g/dL. The mean duration for first intervention (endoscopic cystogastrostomy) was 9.5 weeks after onset of acute pancreatitis, with average endoscopic sessions of 2 to 3. Successful DEN was achieved in 7 patients (87.5%) and mean time to WOPN resolution was 12 weeks. Surgery was needed in one patient due to recurrent pancreatic duct stenosis in the tail of the pancreas. Bleeding as a complication of DEN occurred in one patient, which was oozing from the cystogastrostomy site and stopped spontaneously and did not require transfusion. Limitation: Single center, retrospective, and small number of patients.Table: [1775] Table 1Conclusion: Direct endoscopic necrosectomy is an accepted treatment modality that offers a minimally invasive method of WOPN treatment.Table: [1775] Table 2Disclosure: Dr. Wahid Wassef: Financial relationship with a commercial interest; Boston Scientific Corporation: Self: Salary: Speaking and Teaching; Wilson-Cooke teaching honorarium.