Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis

Georgios I. Papachristou, Naoki Takahashi, Prabhleen Chahal, Michael G. Sarr, Todd H. Baron

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198 Scopus citations

Abstract

BACKGROUND: Experience with minimal access, transoral/transmural endoscopic drainage/debridement of walled-off pancreatic necrosis (WOPN) after necrotizing pancreatitis is limited. We sought to determine outcome using this technique. METHODS: Retrospective analysis. RESULTS: From 1998 to 2006, 53 patients underwent transoral/transmural endoscopic drainage/debridement of sterile (27, 51%) and infected (26, 49%) WOPN. Intervention was performed a median of 49 days (range, 20-300 days) after onset of acute necrotizing pancreatitis. A median of 3 endoscopic procedures/patient (range, 1-12) were performed. Twenty-one patients (40%) required concurrent radiologic-guided catheter drainage of associated or subsequent areas of peripancreatic fluid and/or WOPN. Twelve patients (23%) required open operative intervention a median of 47 days (range, 5-540) after initial endoscopic drainage/debridement, due to persistence of WOPN (n = 3), recurrence of a fluid collection (n = 2), cutaneous fistula formation (n = 2), or technical failure, persistence of pancreatic pain, colonic obstruction, perforation, and flank abscess (n = 1 each). Final outcome after initial endoscopic intervention (median, 178 days) revealed successful endoscopic therapy in 43 (81%) and persistence of WOPN in 10 (19%). Preexistent diabetes mellitus, size of WOPN, and extension of WOPN into paracolic gutter were significant predictive factors for need of subsequent open operative therapy. CONCLUSIONS: Successful resolution of symptomatic, sterile, and infected WOPN can be achieved using a minimal access endoscopic approach. Adjuvant percutaneous drainage is necessary in up to 40% of patients, especially when WOPN extends to paracolic gutters or pelvis. Operative intervention for failed endoscopic treatment is required in about 20% of patients.

Original languageEnglish (US)
Pages (from-to)943-951
Number of pages9
JournalAnnals of surgery
Volume245
Issue number6
DOIs
StatePublished - Jun 1 2007

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ASJC Scopus subject areas

  • Surgery

Cite this

Papachristou, G. I., Takahashi, N., Chahal, P., Sarr, M. G., & Baron, T. H. (2007). Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Annals of surgery, 245(6), 943-951. https://doi.org/10.1097/01.sla.0000254366.19366.69