Endoscopy 2018; 50(04): S188
DOI: 10.1055/s-0038-1637616
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC NECROSECTOMY A SINGLE CENTER EXPERIENCE

A Taha
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroeneterology Department, Brussels, Belgium
,
T Aouattah
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroeneterology Department, Brussels, Belgium
,
R Yeung
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroeneterology Department, Brussels, Belgium
,
T Moreels
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroeneterology Department, Brussels, Belgium
,
H Piessevaux
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroeneterology Department, Brussels, Belgium
,
PH Deprez
1   Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Hepato-Gastroeneterology Department, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Background:

With the emerged endoscopic drainage techniques, there has been an evolution in the treatment of infected pancreatic necrosis and during the last decade several studies showed better outcome for less invasive approaches.

Methods:

Retrospective review of patients that underwent endoscopic necrosectomy between 2007 and 2017. Primary end point was treatment clinical success with improvement in symptoms and no further treatment, and secondary end points radiological success with complete resolution of the collection or small residual collection with no further treatment, survival, major adverse events, and outcomes on long term follow up.

Results:

A total of 16 patients (mean age 54 years; 13 males) underwent 35 sessions of endoscopic necrosectomy. The most frequent etiology was biliary (43.7%) followed by alcohol (37.5%). The mean time for the intervention was 2.7 months from initial presentation. Initial clinical success was achieved in 14 patients (87.5%), and 2 patients were referred to surgical necrosectomy for colonic fistula and fecal peritonitis. Complete radiological success was achieved in 12 patients (75%): 9 patients had complete resolution of the collection, 3 other had residual small collections (< 2 cm) asymptomatic with no further intervention. 2 patients had partial residual collections, treated with endoscopic EUS drainage with favorable outcome. 15 patients survived (93.7%). Adverse events were non-life-threatening bleeding in 2 patients (12.5%) and 1 stent migration (6.2%). 6 patients developed type II diabetes (37.5%), 4 disconnected pancreatic duct syndrome (25%), 4 splenic vein thrombosis (25%), and 2 portal vein thrombosis (12.5%).

Conclusion:

Endoscopic necrosectomy as a step-up approach is a minimally invasive and effective method with high clinical and radiological success rate, with acceptable risk of adverse events. It is however seldom used in a center where medical approach is preferred as initial treatment after acute necrotizing pancreatitis, and when WONs are first treated with EUS guided endoscopic drainage.