Safety and Efficacy of Early (

Abstract

BackgroundEndoscopic transmural drainage is usually not performed for pancreatic necrotic collection (PNC) < 4 weeks after onset of acute necrotizing pancreatitis (ANP) because of lack of encapsulating wall and increased risk of complications. ObjectiveStudy safety and efficacy of early (<4 weeks) endoscopic transluminal drainage in patients with symptomatic PNC. MethodsRetrospective analysis of data base of patients with PNC treated with endoscopic transmural drainage within 4 weeks of onset of ANP (early drainage) was done. The outcomes and complications were compared with patients with PNC who underwent delayed endoscopic drainage (≥4 weeks of onset of ANP). ResultsThirty-four patients (26 males; mean age: 35.9±8.6 years) underwent early and 136 patients (115 males; mean age: 37.9±9.4 years) underwent delayed endoscopic drainage. The PNC was significantly larger (12.3±2.1 cm vs 10.5±2.7 cm, p <0.001) with increased solid component (47.7 ± 8.9% vs 28.3 ± 11.7%, p <0.001) in the early group. Clinical success was achieved in 94% patients in the early group and all patients in the delayed group. Direct endoscopic necrosectomy was performed more frequently in the early group (50% vs 7.4%; p<0.001). There was increased mortality (5.7% vs 0%), need for rescue surgical necrosectomy (5.7% vs 0%), and clinically significant bleeding (20% vs 1.5%, p<0.001) in the early group as compared to the delayed group. ConclusionEarly endoscopic drainage of PNC is feasible and seems to be safe as well as effective but is associated with increased risk of complications as compared to delayed drainage.