Pancreatic necrosis and pancreatic abscess are severe complications of acute pancreatitis.
Surgery is associated with significant morbidity and mortality in these critically ill patients.
Endoscopic therapy has the potential to offer a safer and more effective alternative treatment modality.
However, its role needs to be further investigated.
| Pancreatic necrosis and abscesses were successfully drained in all 13 patients|
Dr Stefan Seewald and colleagues conducted a retrospective study of the outcome of 13 consecutive patients with pancreatic necrosis and pancreatic abscess.
The team reported that all patients were unfit to undergo surgery, and underwent a new aggressive endoscopic approach.
The treatment included synchronous endoscopic ultrasonography-guided multiple transmural and/or transpapillary drainage procedures.
The transpapillary drainage procedure was followed by balloon dilation of the cystogastrostoma or cystoduodenostoma.
The researchers reported other treatment including daily endoscopic necrosectomy and saline solution lavage.
Sealing of pancreatic fistula by N-butyl-2-cyanoacrylate was also part of the treatment protocol.
The researchers found that pancreatic necrosis and abscesses were successfully drained in all 13 patients, thereby avoiding emergency surgery as an initial treatment.
The team noted that surgery was completely avoided in 9 patients over a median follow-up of 8 months.
Surgery was combined with endoscopic therapy in 1 patient because of abscess extension into the right paracolic gutter, not manageable by endoscopic drainage.
The team observed that 2 patients later developed recurrent pseudocysts and underwent elective surgery because of the “disconnected-duct syndrome”.
Complications included minor bleeding after balloon dilation and necrosectomy in 4 cases, which were self limiting or controlled endoscopically.
Dr Seewald's team concludes, “This aggressive endoscopic approach shows promising results.”
“It expands the potential for endoscopic treatment in patients with pancreatic necrosis and/or pancreatic abscess.”