EXPERIENCE WITH ENDOROTORXT FOR ENDOSCOPIC NECROSECTOMY IN PATIENTS WITH ACUTE NECROTIC PANCREATITIS AT A TERTIARY CARE CENTER

Aims Acute necrotic pancreatitis is a devastating disease with mortality rates ranging from 26 - 86%. Recent development of a lumen apposing metal stent (LAMS) has improved endoscopic therapies but is limited by the lack of dedicated endoscopic tools. The EndoRotor XT is a novel mechanical endoscopic debridement system designed for this purpose. So far only 2 cases of pancreatic necrosis treated by EndoRotor have been described in the literature.

Methods A retrospective chart review of all cases of pancreatic necrosis in which EndoRotor mechanical debridement was employed. All patients underwent cystgastrostomy with placement of a 15x10mm LAMS at a prior endoscopy and presented for follow up necrosectomy. A double channel therapeutic endoscope was used for EndoRotor debridement. All patients had greater than 30% cyst wall involvement of necrosis.

Results Four patients, all male with an average age of 49 had a mean maximal axial cyst diameter of 151 mm and underwent an average of 1.25 (1 patient had 2 sessions) EndoRotor mechanical debridement necrosectomies. Complete cyst resolution was observed in 75% of patients (one is currently still being treated) with mean time to resolution being 84 days. Mean length of hospital stay and time to discharge after treatment was 33 and 19 days, respectively. There were no patient complications and only one technical complication of the EndoRotor getting caught on the LAMS. This was remedied by removal of the stent and the EndoRotor without any further sequelae.

Conclusions Evolving technologies for endoscopic debridement present opportunities to improve patient outcomes in pancreatic necrosis. None of our patients to date required additional surgical or interventional radiology procedures. One patient was managed as an outpatient, and 2 others were able to achieve early discharge. One technical complication was observed but the procedure was well tolerated by all patients.