Endoscopy 2013; 45(08): 627-634
DOI: 10.1055/s-0033-1344027
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study

I. Yasuda
1  First Department of Internal Medicine, Gifu University Hospital, Gifu
,
M. Nakashima
1  First Department of Internal Medicine, Gifu University Hospital, Gifu
,
T. Iwai
2  Department of Gastroenterology, Kitasato University East Hospital, Sagamihara
,
H. Isayama
3  Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo
,
T. Itoi
4  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo
,
H. Hisai
5  Department of Gastroenterology, Japan Red Cross Date General Hospital, Date
,
H. Inoue
6  Department of Gastroenterology, Mie University Hospital, Tsu
,
H. Kato
7  Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama
,
A. Kanno
8  Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai
,
K. Kubota
9  Division of Gastroenterology, Yokohama City University School of Medicine, Yokohama
,
A. Irisawa
10  Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizu
,
H. Igarashi
11  Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Fukuoka
,
Y. Okabe
12  Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume
,
M. Kitano
13  Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama
,
H. Kawakami
14  Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo
,
T. Hayashi
15  Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo
,
T. Mukai
16  Department of Gastroenterology, Gifu Municipal Hospital, Gifu
,
N. Sata
17  Department of Surgery, Jichi Medical University, Tochigi, Japan
,
M. Kida
2  Department of Gastroenterology, Kitasato University East Hospital, Sagamihara
,
T. Shimosegawa
8  Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai
› Author Affiliations
Further Information

Publication History

submitted 18 November 2012

accepted after revision 26 March 2013

Publication Date:
27 June 2013 (online)

Background and study aims: Only a few large cohort studies have evaluated the efficacy and safety of endoscopic necrosectomy for infected walled-off pancreatic necrosis (WOPN). Therefore, a multicenter, large cohort study was conducted to evaluate the efficacy and safety of endoscopic necrosectomy and to examine the procedural details and follow-up after successful endoscopic necrosectomy.

Patients and methods: A retrospective review was conducted in 16 leading Japanese institutions for patients who underwent endoscopic necrosectomy for infected WOPN between August 2005 and July 2011. The follow-up data were also reviewed to determine the long-term outcomes of the procedures.

Results: Of 57 patients, 43 (75 %) experienced successful resolution after a median of 5 sessions of endoscopic necrosectomy and 21 days of treatment. Complications occurred in 19 patients (33 %) during the treatment period. Six patients died (11 %): two due to multiple organ failure and one patient each from air embolism, splenic aneurysm, hemorrhage from a Mallory – Weiss tear, and an unknown cause. Of 43 patients with successful endoscopic necrosectomy, recurrent cavity formation was observed in three patients during a median follow-up period of 27 months.

Conclusions: Endoscopic necrosectomy can be an effective technique for infected WOPN and requires a relatively short treatment period. However, serious complications can arise, including death. Therefore, patients should be carefully selected, and knowledgeable, skilled, and experienced operators should perform the procedure. Further research into safer technologies is required in order to reduce the associated morbidity and mortality.