Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique.

Abstract

Endoscopic management of walled-off pancreatic necrosis (WOPN) is an area of great interest with many still unanswered questions, including the role of mechanical necrosectomy versus irrigation. The aim of this study was to evaluate a new method of endoscopic transmural necrosectomy. Patients with WOPN after necrotizing pancreatitis, who underwent endoscopic transmural necrosectomy using a lumen-apposing metal stent with vigorous irrigation sessions, were prospectively recruited between September 2011 and August 2014. Initial endoscopic session was performed by EUS-guided drainage and lavage sessions by flushing saline through the stent. Technical and clinical success rates, number of repeat interventions, and adverse events were analyzed. Twelve patients with 13 WOPN collections (median size 12.4±2.94cm) underwent endoscopic treatment. Clinical success was achieved in 100% of cases after a median of three sessions per patient (range 2-8). The median length of hospitalization was 15.9days. Median procedure time of the access session was 31±10.16min. No adverse events (AE) were described during the procedures or 24h after. There were four AE (two infections and two bleedings) between sessions, but only two were severe (16.6%). There was no need for surgery, and no mortalities occurred. Mean time to stent retrieval was 9±3.4weeks. Mean follow-up was 13months with only one recurrence at 12months after stent removal. This new variant of irrigation endoscopic transmural necrosectomy without mechanical debridement helps to simplify the technique, is feasible, and has excellent outcomes in WOPN treatment.