Tu1440 A NOVEL TOOL FOR FAST AND EFFECTIVE ENDOSCOPIC REMOVAL OF PANCREATIC NECROSIS

Abstract

Acute pancreatitis may run a severe course when pancreatic necrosis becomes infected. Invasive treatment of these patients is virtually always necessary and over the last decade the treatment has changed dramatically towards less invasive treatments. Endoscopic drainage and ensuing necrosectomy have been shown to be effective in the management of pancreatic necrosis. One of the main limitations during endoscopic management is the lack of dedicated and effective instruments to remove pancreatic necrotic tissue, resulting in time consuming procedures with marginal results and often necessitating multiple procedures. We aimed to evaluate the technical feasibility, safety and clinical outcome of the EndoRotor®, a novel automated mechanical endoscopic resection system to suck, cut and remove small pieces of tissue in patients with necrotizing pancreatitis. Subjects with infected walled-off pancreatic necrosis were endoscopically treated using the EndoRotor® device. Procedures were performed under conscious or propofol sedation by four endoscopists with a broad experience in advanced endoscopic procedures including conventional endoscopic necrosectomy. Endoscopists were additionally asked to fill out a short questionnaire about their experience using the EndoRotor®. Six patients have been endoscopically treated for pancreatic necrosis, five patients were men and the median age was 61.7 years (range 43-71). Imaging data of the pancreas revealed a mean necrotic collection size of 114.7mm diameter (range 50-180mm). Transgastric drainage was performed in all patients, four patients received plastic stents and two a fully covered lumen apposing stent. Three patients were previously treated unsuccessfully with conventional tools with a median of two procedures (range 1-3). Additionally, the EndoRotor® was used in six patients with a total of 16 procedures, the average procedure length was 46.5 minutes (range 32-80). To achieve complete removal of pancreatic necrosis, the median number of required procedures was two per patient (range 1-7). No procedure-related adverse events occurred. Endoscopists agree on the ease of use and effective removal of necrotic tissue with the EndoRotor®, rating both 8.3 on a 10-point scale. They are especially satisfied by the ability to manage the removal of necrotic tissue in a controlled way (8.6 on a 10-point scale). Moreover, they are convinced that this device is of additional value in the management of pancreatic necrosis (8.6) and are willing to use it again (9.3 on a 10-point scale). Initial experience with the EndoRotor® suggests that this device can safely, quickly and effectively remove pancreatic necrosis.