ENDOSCOPIC MICRODEBRIDER-ASSISTED NECROSECTOMY FOR WALLED-OFF PANCREATIC NECROSIS

Aims Debridement of infected walled-off pancreatic necrosis (WOPN) is indicated to treat ongoing infection and sepsis-related multi-organ failure. The lack of dedicated and effective accessories results in the need for time-consuming repetitive procedures. The aim of this prospective international multicenter study is to evaluate the use of a new 3.1 mm flexible microdebrider catheter (EndoRotor) to remove solid debris under direct endoscopic visualization in patients with WOPNs.

Methods All patients underwent prior CT scan which had to show WOPN of ≥ 6cm and ≤ 22cm in size with ≥30% solid component. Endoscopic drainage (by either LAMS, SEMS or DPS) was carried out at least three days before endoscopic microdebrider-assisted necrosectomy was performed through the gastrostoma under direct visualization. Adverse events (AE), procedure times, number of procedures until resolution, percentage decrease of solid necrosis per session, decrease of WOPN size on follow-up CT scans (21 days after final session) and time to discharge were documented.

Results Here we present interim data of the first 12 patients who underwent microdebrider-assisted necrosectomy within the study. No microdebrider-associated adverse events, including bleeding were reported. A mean of 1.8 interventions (range 1-4) were required with an average microdebrider procedure time of 77 minutes and a total procedure time of 180 minutes. There was a mean 63.0% reduction of solid necrosis after the first session. The mean decrease of cavity size was 86.8% comparing pre- and post-procedural CT scans. Time from microdebrider-assisted necrosectomy to discharge averaged 6 days (range 0-12 days).

Conclusions Microdebrider-assisted necrosectomy for WOPN is a feasible and safe procedure that can provide very effective endoscopic clearance of solid debris without device-associated adverse events.