Treatment Of Walled-off Pancreatic Necrosis Research Articles

Impact of long-term transmural plastic stents on recurrence after endoscopic treatment of walled-off pancreatic necrosis

Background and study aims: Endoscopic transmural drainage (ETD) using double pigtail stents (DPS) is a well-established treatment for walled-off pancreatic necrosis (WON). This study aimed to compare outcomes in patients undergoing ETD with DPS left indwelling versus those where stents were removed or migrated. Patients and methods: This retrospective, multicenter cohort study included patients with WON who underwent ETD using DPS between July 2001 and December 2019. The primary outcome was recurrence of a pancreatic fluid collection (PFC). Secondary outcomes were long term complications and recurrence-associated factors. Competing risk regression analysis considered DPS removal or migration as time-varying covariate. Results: Among 320 patients (median age 58, 36% female), DPS were removed in 153 (47.8%), migrated spontaneously in 27 (8.4%), and remained indwelling in 140 (43.8%). PFC recurrence was observed in 57 patients (17.8%): after removal in 39 (25.5%), after migration in 4 (14.8%) and in patients with indwelling DPS in 14 patients (10%). In 25 patients (7.8%) drainage of recurrent PFC was indicated. Risk factors for recurrence were DPS removal or migration (HR: 3.45, 95%CI: 1.37–8.70) and presence of a disconnected pancreatic duct (HR: 3.45, 95%CI: 1.84–14.0). Conclusions: Among patients who undergo ETD of WON, leaving DPS in situ seems to lower the risk on recurrent fluid collections, without any long term DPS-related complications. These results suggest that DPS should not be routinely removed and can be safely left indwelling indefinitely.

Safety and efficacy of the EndoRotor device for the treatment of walled-off pancreatic necrosis after EUS-guided cystenterostomy: A systematic review and meta-analysis

ABSTRACT Debridement of infected walled-off pancreatic necrosis is indicated to treat and prevent sepsis-related multiorgan failure. The aim of this study was to evaluate the efficacy and safety of the EndoRotor-powered endoscopic debridement system to remove solid debris under direct endoscopic visualization. Search strategies were developed for PubMed, EMBASE, and Cochrane Library databases from inception to June 2022, in accordance with Preferred Reporting items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Outcomes of interest included technical success defined as successful use of device for debridement, clinical success defined as complete debridement and cyst resolution, and procedure-related adverse events. A random-effects model was used for analysis, and results were expressed as odds ratio along with 95% confidence interval. A total of 7 studies (n = 79 patients) were included. The mean walled-off pancreatic necrosis size was 154.6 ± 34.0 mm, whereas the mean procedure time was 71.4 minutes. The mean number of necrosectomy sessions required was 2.2 (range, 1–7). The pooled rate of clinical success was 96% (95% confidence interval, 91%–100%; I 2 = 0%) with a pooled technical success rate of 96% (91%–100%; I 2 = 0%). The pooled procedure-related adverse event rate was 8% (2%–14%; I 2 = 6%), which included procedure-associated bleeding, pneumoperitoneum, peritonitis, pleural effusion, and dislodgement of lumen-apposing metal stents. Our study shows that the novel EndoRotor device seems to be safe and effective for treating pancreatic necrosis. Patients undergoing endoscopic necrosectomy with the EndoRotor seem to require less debridement sessions when compared with studies using conventional instruments.

S1118 Safety and Efficacy of the Novel EndoRotor Device for the Treatment of Walled-Off Pancreatic Necrosis (WOPN): A Systematic Review and Meta-Analysis

Introduction: Debridement of infected walled-off pancreatic necrosis (WOPN) is indicated to treat and prevent sepsis-related multi-organ failure. The lack of dedicated and effective accessories for WOPN debridement results in the need for time-consuming repetitive procedures. The aim of this study was to evaluate the efficacy and safety of the EndoRotor® powered endoscopic debridement system to remove solid debris under direct endoscopic visualization. Methods: Search strategies were developed for PubMed, EMBASE, and Cochrane Library databases from inception through June 2022, in accordance with PRISMA and MOOSE guidelines. Outcomes of interest included technical success defined as successful use of device for debridement, clinical success defined as complete debridement and cyst resolution, and procedure-related adverse events. A random effects model was used for analysis and results were expressed as Odds ratio (OR) along with 95% confidence interval (CI). Results: A total of 8 studies (n = 91 patients) were included. The most common etiology of WOPN was biliary (30%). Mean WOPN size was 154.6 ± 34.0 mm, while mean procedure time was 71.4 minutes. LAMS were used to create a cystgastrostomy for 73.6% of cases with the remaining cases relying upon a placement of plastic stents (24.2%) and self-expanding metal stents (SEMS) (2.2%). The mean number of necrosectomy sessions required was 2.2 (range 1 to 7). The pooled rate of clinical success was 97% (95% CI 93-100%, I2 = 0%) with a pooled technical success rate of 97% (93-100%, I2 Z54%). The pooled procedure-related adverse event rate was 7% (2-12%, I2 = 0%), which included procedure-associated bleeding, pneumoperitoneum, peritonitis, pleural effusion, and dislodgement of LAMS. Overall publication bias was considered low. (Figure) Conclusion: Our study illustrates that the novel EndoRotor device appears to be safe and effective for treating pancreatic necrosis. Patients undergoing endoscopic necrosectomy with the EndoRotor appear to require less debridement sessions when compared with studies using conventional instruments.Figure 1.: Forrest plot of pooled rates of clinical success.

Endoscopic ultrasonography guided endoscopic necrosectomy in the treatment of walled-off pancreatic necrosis: Case report

Walled-off pankreatik nekroz, akut nekrotizan pankreatitin geç aşamasında gelişen ciddi bir lokal komplikasyondur. Nekrotik içerik enfekte olduğunda, hayatı tehdit eden bir komplikasyon haline gelir. Hastaların yarısında basınç, enfeksiyon, mide çıkış ve biliyer obstrüksiyonu ile ilişkili semptomlar gelişir. Semptomatik hastalarda organize nekrotik materyalin debridmanı gerekir. Eskiden, walled-off pankreatik nekrozun standart tedavisi açık cerrahi yöntem olsa da yüksek morbidite ve mortalite ile ilişkilidir. Bu nedenle, radyolojik ve endoskopik gibi minimal invaziv yöntemlerin ortaya çıkmasıyla açık cerrahinin rolü giderek azalmıştır. Günümüzde özellikle endoskopik ultrasonografi ile birlikte endoskopik teknikler ve aksesuarlardaki gelişmeler, peripankreatik sıvı koleksiyonlarının endoskopik tedavilerinde devrim yaratmıştır. Diğer yöntemlere göre daha düşük morbidite, mortalite ve hastanede kalış süresi ile ilişkili olan endoskopik yöntemler giderek daha çok tercih edilmektedir. Bu yazıda, endoskopik ultrasonografi eşliğinde transluminal drenaj ve endoskopik nekrozektomi yapılan walled-off pankreatik nekroz olgusunu sunuyoruz.

P-P09 Salvage transgastric necrosectomy as a part of a step-up approach to managing acute necrotising pancreatitis

Abstract Background The use of EUS (endoscopic ultrasound) guided drainage with endoscopic LAMS (lumen apposing metal stent) necrosectomy is an emerging treatment option for walled-off pancreatic necrosis (WOPN) secondary to acute severe pancreatitis. It can delay or remove the need for surgical necrosectomy, which can be associated with high morbidity and mortality. However, the endoscopic approach is not always successful due to a multitude of factors and salvage transgastric necrosectomy can be performed using the tract created by the LAMS to achieve internal drainage and remove necrotic pancreas.  Methods We describe our unit’s experience in managing WOPN in two patients. We suggest a treatment pathway of WOPN which includes a step-up approach including salvage transgastric necrosectomy in patients where multiple endoscopic necrosectomies and washouts have failed.  Results Two patients, aged 67 and 69, were admitted as intensive care transfers for gallstone and alcohol pancreatitis respectively. They underwent a step-up approach to treat their infected WOPN, starting with the deployment of LAMS and endoscopic necrosectomy. They both showed brief clinical improvement after repeated endoscopic necrosectomy but further imaging showed ongoing large collections that could not be treated endoscopically. Both patients underwent successful transgastric open necrosectomy where necrotic pancreatic tissue was accessed surgically through the already created cyst-gastrostomy. This had the advantage of internal drainage of the collection into the stomach without the need for external surgical drains. Conclusions The emphasis in the treatment of WOPN has shifted to minimally invasive percutaneous or endoscopic drainage modalities. Endoscopically inserted LAMS may not always achieve definitive drainage of the WOPN but should be employed in the first instance as they are associated with reduced morbidity and mortality compared to surgery. Ultimately, open necrosectomy with washout remains the definitive management strategy in the step-up approach. We believe that the trans-gastric open necrosectomy approach can be used successfully in patients where the minimally invasive approach has failed. 

Laparoscopic transgastric necrosectomy in treatment of walled-off pancreatic necrosis with sinistral portal hypertension

BackgroundLaparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. However, the safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear.MethodsWON patients with sinistral portal hypertension treated in our department between January 2011 and December 2018 were included and retrospectively analyzed in this study. Patients were divided into two groups according to different surgical approaches, LTNG or laparoscopic assisted trans-lesser sac necrosectomy (LATLSN). Perioperative and long-term outcomes were compared between two groups.Results312 cases diagnosed with WON were screened and 53 were finally included in this study. Of the included patients, 21 and 32 cases were received LTGN and LATLSN, respectively. LTGN was associated with significantly lower morbidity than LATLSN (19.0% vs 46.9%, p = 0.04) and similar severe complication (Clavien–Dindo ≥ III) rate (12.5% vs 19.0%, p = 0.70). LTGN did not increase the rate of postoperative hemorrhage (9.5% vs 6.3%, p = 1.00) and mortality (9.5% vs 9.4%, p = 1.00). After 39 (11–108) months follow-up, the recurrence rate of WON and long-term complications were also comparable between groups.ConclusionFrom current data, LTGN was safe and effective in treatment of WON patients with sinistral portal hypertension in terms of short- and long-term outcomes.

Endoscopic drainage of walled-off pancreatic necrosis: is necrosectomy and delayed drainage necessary?

Introduction: While studies have suggested that endoscopic step up approach with delayed drainage (more than 28 days from symptom onset) produce the best outcome in the treatment of walled-off pancreatic necrosis (WOPN), we assessed our single centre experience with endoscopic drainage of WOPN, in particular, the necessity of necrosectomy and delayed drainage. Methods: Patients who underwent endoscopic drainage for WOPN between October 2011 and June 2019 in Monash Health were identified. They were excluded if follow up data were missing. The included patients' medical records, pathology results, imaging findings and procedure reports were retrospectively reviewed. The outcomes were then compared between early drainage (within 28 days of symptom onset) and delayed drainage cohorts. Results: 38 patients were included for analysis. The population underwent an average of 2.45 endoscopic drainages per patient with none requiring endoscopic necrosectomy. 31.58%% of patients required percutaneous drainage for distant collections and 2 patients received surgical necrosectomy. A disease related mortality of 15.8% and an average length of stay (LOS) of 75.71 days were reported. No statistically significant difference was shown in disease -related mortality (27.3% vs. 11.1%, p = 0.215) or LOS (90.9 vs 69.5, p=0.2905) between early and delayed drainage cohorts, but patients who received early drainage were more unwell at day 18 of symptom onset (qDOFA score 1 vs. 0.3, p= 0.033). Conclusion: Endoscopic drainage in combination with selective percutaneous drainage is effective in the management of walled-off pancreatic necrosis. Early drainage should be considered for patient who remained unstable despite conservative management.

Lumen-Apposing Metal Stents for Walled-Off Pancreatic Necrosis: A Practice Pattern Survey of Gastroenterologists

<h2>ABSTRACT</h2><h3>Background & Aims</h3> Endoscopic ultrasound-guided placement of LAMS has emerged as an effective treatment for WON following acute necrotizing pancreatitis, but a standardized management protocol has not yet emerged. We sought to characterize practice variations in the use of lumen-apposing metal stents (LAMS) for the treatment of walled-off pancreatic necrosis (WON). <h3>Methods</h3> A 30-question survey was sent to 341 endoscopists in the United States to collect information on practitioner demographics, procedural practices, necrosectomy practices, and LAMS-related adverse events. <h3>Results</h3> A total of 69 of the 341 surveys were completed for a response rate of 20.2%. Almost all reported using LAMS placement as the primary method of WON treatment (92.5%). At the time of LAMS placement, almost half of respondents perform balloon dilation (45.2%), and a minority place pigtail stents through the LAMS channel (15.0%). Necrosectomy is performed by less than half during index LAMS placement procedure (46.8%). Approximately half never use hydrogen peroxide lavage (52.4%). Most respondents reported experiencing adverse events at some point. About half reported a stent indwell time of the greater than 1 month. <h3>Conclusion</h3> A convergence of practice patterns when using LAMS to treat WON has not been demonstrated. Considerable variability exists in certain aspects of LAMS use including placement technique, necrosectomy practices, follow-up treatment, and stent removal. Further investigation is necessary to standardize this procedure to effectively and safely treat WON.

Endoscopic treatment with transmural drainage and necrosectomy for walled-off necrosis provides favourable long-term outcomes on pancreatic function.

Several studies have shown improved short-term outcome with endoscopic transmural drainage and necrosectomy for the treatment of walled-off pancreatic necrosis. However, knowledge on the long-term prognosis after such treatment is limited. The aim of present study was to evaluate long-term outcomes in patients endoscopically treated with transmural drainage and necrosectomy. We retrospectively follow up 125 patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy in 2010-2017. All patients received plastic pigtail stents and nasocystic catheter. Additional external drainage was performed in 41 patients. Main outcomes were survival, pancreatic function, development of co-morbidities, ability to work and social status. During a median follow-up of 4.3 years, nine (7%) patients died. Seven deaths were unrelated to pancreatic disease, and two patients died of pancreatic cancer. Twenty-two (18%) patients developed exocrine pancreatic insufficiency. Thirty-six (32%) previous non-diabetics developed endocrine insufficiency. Endoscopic necrosectomy during admission (odds ratio (OR) = 1.28, 95% confidence interval (CI) 1.05-1.56; p = 0.015) and therapy on the main pancreatic duct (OR = 8.08, 95% CI 2.43-26.9; p < 0.001) during follow-up predicted development of exocrine insufficiency. Severity on computed tomography predicted endocrine insufficiency (OR = 1.61, 95% CI 1.24-2.09; p < 0.001). Most patients regained their working capacity and preserved their marital status. This study provides robust data on the long-term outcome of patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy. The favourable outcomes on survival, pancreatic function and social status support current recommendations of endoscopic transmural drainage and necrosectomy being the treatment of choice for walled-off pancreatic necrosis.

730 MANAGEMENT OF WALLED OFF PANCREATIC NECROSIS WITH NASOCYSTIC IRRIGATION VERSUS LUMEN APPOSING METAL STENT (LAMS) - RANDOMIZED CONTROLLED TRIAL

Walled off pancreatic necrosis (WON) is an important complication of acute necrotizing pancreatitis (ANP). There are limited data on comparison of nasocystic irrigation versus lumen apposing metal stent (LAMS) in management of WON. We compare the technical and clinical success of both the treatment strategies. A randomized controlled trial conducted on patients with ANP with symptomatic WON who were randomized to nasocystic irrigation with hydrogen peroxide (group A) and LAMS placement (group B). ANP was diagnosed based on clinical features, laboratory parameters and imaging. Primary end points were clinical and technical success of both the procedures. 47 patients were randomized till date to group A (n=24, age 37.8±27.4 years, 15 men) and group B (n=23, age 40.9±20.6 years, 17 men). There were no significant difference in baseline characteristics between the two groups. Most common etiology was alcohol observed in 27(57.4%) patients and most common symptom was abdominal pain seen in all patients. Technical success (100% vs 91.4%, p=0.95) and clinical success (83.33% vs 78.3%, p =0.9), additional procedures to get clinical success (15% vs 21.66%, p=0.9) and complications (4 vs 5, p=0.9) were comparable in both the groups. The duration to get clinical success (35.5±49.1 days vs 14.9 ±24.8 days, p =0.004) was longer in group A compared to group B. LAMS and nasocystic irrigation with H2O2 are equally effective in the treatment of WON but duration of clinical success is longer with nasocystic irrigation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Successful endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticopleural and pancreaticocolonic fistulas.

Successful endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticopleural and pancreaticocolonic fistulas.

Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage of walled-off pancreatic necrosis (WOPN).

The endoscopic treatment of walled-off pancreatic necrosis (WOPN) as well as other minimally invasive methods have been evolving since last years. The aim of this study is evaluation of efficiency and safety of endoscopic necrosectomy under fluoroscopy done during the transmural drainage in patients with symptomatic WOPN. The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016. The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016. Endoscopic necrosectomy was performed under fluoroscopic guidance during transmural drainage in 24/114 (21.05%) patients. The mean amount of endoscopic procedures in each patient was 8.88 (3-27). The active drainage was continued averagely for 40.1 (11-96) days. The avarage number of necrosectomy procedures during continued drainage was 6.54 (1-24) per patient. Additional percutaneous drainage was applied in just two patients. The complications of endotherapy were present in 9/24 (37.5%) patients. The therapeutic success was reached in 23/24 (95.83%) patients. The mean time of observation was 35 [18-78] months. The recurrence of pancreatic fluid collection was stated in 4 patients during the observation time. The mean time between the end of endotherapy and recurrence of fluid collection was 19 [16-22] months. In three patients recurrent fluid collections were treated endoscopically and in one patient were treated surgically. Long-term success of endoscopic treatment of WOPN was reached in 22/24 (91.67%) patients. Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage is successful and safe method of minimally invasive treatment in selected patients with walled-off pancreatic necrosis.

Endoscopic treatment of walled-off pancreatic necrosis by simultaneous transgastric and retroperitoneal approaches.

Endoscopic treatment of walled-off pancreatic necrosis by simultaneous transgastric and retroperitoneal approaches.

Treatment of walled-off pancreatic necrosis.

To review the current management of walled-off pancreatic necrosis (WOPN). The management of WOPN has evolved. Many collections do not require intervention and may resolve over time. Nutritional support and treatment of infection are two critical components of medical management. For collections requiring drainage, minimally invasive endoscopic therapies now play a primary role. Endoscopic transmural puncture with stent placement may provide access for drainage and decompression. More complex collections may require transluminal instrumentation with lavage, debridement, and necrosectomy. Concurrent pancreatic duct injuries including strictures, leaks, and disconnections are very common. Addressing the pancreatic ductal injury is a key component in the long-term success of management strategies. Providing high-level care for patients requires a multidisciplinary approach with providers specialized in the management of severe acute pancreatitis and associated complications. Minimally invasive management strategies improve the outcomes for patients with WOPN. Close follow-up, medical therapy, and nutritional support are required for most patients. Endoscopic transmural drainage and necrosectomy are the primary approaches for collections requiring intervention. Protocols for endoscopic drainage are being refined to reduce side effects and decrease the number of interventions required for resolution.

Retrospective Validation of an Algorithmic Treatment Pathway for Necrotizing Pancreatitis

The role of surgical intervention for necrotizing pancreatitis has evolved; however, no widely accepted algorithm has been established to guide timing and optimal modality in the minimally invasive era. This study aimed to retrospectively validate an established institutional timing- and physiologic-based algorithm constructed from evidence-based guidelines in a high-volume hepatopancreatobiliary center. Patients with necrotizing pancreatitis requiring early (≤six weeks from symptom onset) or delayed (>six weeks) surgical intervention were reviewed over a four-year period (n = 100). Early intervention was provided through laparoscopic drain-guided retroperitoneal debridement (n = 15) after failed percutaneous drainage unless they required an emergent laparotomy (due to abdominal compartment syndrome, bowel necrosis/perforation, or hemorrhage) after which conservative, sequential open necrosectomy was performed (n = 47). Robot-assisted (n = 16) versus laparoscopic (n = 22) transgastric cystgastrostomy for the delayed management of walled-off pancreatic necrosis was compared, including patient factors, operative characteristics, and 90-day clinical outcomes. Major complications after early debridement were similarly high (open 25% and drain-guided 27%), yet 90-day mortality was low (open 8.5% and drain-guided 7.1%). Patient and operative characteristics and 90-day outcomes were statistically similar for robotic versus laparoscopic transgastric cystogastrostomy. Our evidence-based algorithm provides a stepwise approach for the management of necrotizing pancreatitis, emphasizing minimally invasive early and late interventions when feasible with low morbidity and mortality. Robot-assisted transgastric cystogastrostomy is an acceptable alternative to a laparoscopic approach for the delayed treatment of walled-off pancreatic necrosis.

The cost of endoscopic treatment for walled-off pancreatic necrosis

BackgroundUse of minimally invasive techniques has reduced mortality in walled-off pancreatic necrosis (WON) but may be costly. The aim of this study was to evaluate the actual costs associated with the endoscopic management of patients with WON. MethodsWe included a retrospective cohort of WON patients treated with endoscopic, transgastric drainage and necrosectomy (ETDN) during 2013–2014. Costs were calculated for six sub-areas based on a micro-costing model. Students T-test and non-parametric analysis of variance were performed to evaluate costs in relation to disease etiology and outcome. ResultsWe included 58 patients (50% men, median age 57 years). The most common etiologies were gallstones (57%) and alcohol (19%). Nine patients (16%) died during admission. The median length of stay was 50 days (IQR 31 days). Eighteen patients (31%) needed treatment in our intensive care unit with a median length of stay of 16 days (IQR 31 days). The mean costs and standard deviation of costs (SD) per patient were: diagnostic imaging $2,431 ($2,301), laboratory tests $3,579 ($2,477), blood products $982 ($1,734), endoscopic treatment $3,794 ($1,777), medicine $5,440 ($6,656), and ward cost $41,260 ($35,854). The mean total cost was $57,486 ($46,739). Post-ERCP pancreatitis and mortality predicted higher costs. ConclusionsThis study sheds light on the different costs associated with endoscopic treatment of WON. As nearly three quarters of the costs are related to ward care, initiatives aimed at reducing the length of hospital stay may have a great impact on making endoscopic treatment more cost effective.

Lumen-apposing Metal Stent With or Without Coaxial Plastic Stent for Treatment of Walled-off Pancreatic Necrosis

Lumen-apposing Metal Stent With or Without Coaxial Plastic Stent for Treatment of Walled-off Pancreatic Necrosis

LAMS vs. Plastic Stents for Treatment of Walled-Off Pancreatic Necrosis

It is not hyperbole to say that lumen-apposing metal stents (LAMS) have revolutionized the endoscopic drainage and debridement of pancreatic fluid

Endoscopic treatment of walled-off pancreatic necrosis complicated with pancreaticocolonic fistula

BackgroundPancreaticocolonic fistulas (PCFs) are serious complication of acute pancreatitis related with high mortality. The aim of this study was to evaluate the efficiency and safety of endoscopic treatment in patients with walled-off pancreatic necrosis (WOPN) complicated with PCF.MethodsThis is a retrospective analysis of results and complications in the group of 226 patients, who underwent endoscopic treatment of symptomatic WOPN between years 2001 and 2016 in the Department of Gastroenterology and Hepatology of Medical University of Gdańsk.ResultsPCF was recognized in 21/226 (9.29%) patients. Transmural drainage was performed in 20/21 (95.24%) patients. Transpapillary drainage was used in 2/21 (9.52) patients. The mean time since the start of endotherapy to the diagnosis of a fistulas was 9 (3–21) days. Fluoroscopic nasocystic tube-check imaging of an existing drain was the initial imaging diagnosis of a PCF in 19/21 (90.48%) patients. The mean duration of endoscopic drainage of WOPN was 39.29 (15–87) days. Procedure-related adverse events occurred in 10/21 (47.62%) patients and most of them were treated conservatively. Three patients required surgical treatment. One patient died during endotherapy. The closure of PCF was confirmed via imaging in 17/21 (80.95%) patients. The average time since the recognition till the closure of PCF was 21 (14–48) days. Complete therapeutic success of WOPN complicated with PCF was reached in 16/21 (76.19%) patients. Long-term success of endoscopic treatment was achieved in 15/21 (71.43%) patients.ConclusionsEndoscopic treatment of patients with WOPN complicated with PCF is an effective method with an acceptable number of complications. The complete regression of the WOPN may lead to spontaneous closure of pancreaticocolonic fistulas.

The Development of Endoscopic Techniques for Treatment of Walled-Off Pancreatic Necrosis: A Single-Center Experience

Background Endotherapy is a common method of treatment in patients with symptomatic walled-off pancreatic necrosis (WOPN). The aim of this study is to indicate the potential therapeutic possibilities created by the combination of several new endoscopic techniques and the evaluation of their efficacy in the treatment of WOPN. Methods The retrospective analysis of results and complications in the group of 101 patients, who underwent endoscopic treatment of symptomatic WOPN between years 2011 and 2015. Results Endoscopic treatment was started in 101 patients (71 men, 30 women; mean age 50.97 years) with symptomatic WOPN. Single transluminal gateway technique (SGT) was used in 93/101 (92.08%) patients. SGT in combination with multiple transluminal gateway technique (MTGT) was exploited in 4/93 (4.30%) patients, while in combination with single transluminal gateway transcystic multiple drainage (SGTMD) in 22/93 (23.66%) patients. Transpapillary access was used in 11/101 (10.89%) patients. 20/101 (19.80%) patients underwent percutaneous drainage. Fluoroscopy-guided endoscopic necrosectomy was performed in 19/101 (18.81%) patients. The combinations of endoscopic techniques depended on the extent of necrosis. Procedure-related complications occurred in 16/101 (15.84%) patients. The mortality rate was 0.99% (1/101 patient). Therapeutic success was achieved in 99/101 (98.02%) patients. The long-term success of endoscopic treatment was achieved in 97/101 (96.04%) patients with symptomatic WOPN. Conclusions Application of new endoscopic techniques in the treatment of the patients with symptomatic WOPN significantly improves the efficiency of endotherapy with an acceptable amount of complications.