Abstract
Background and aims Endoscopic ultrasound (EUS) guided drainage of symptomatic pancreatic walled-off
necrosis (WON) followed by fully covered self-expanding metal stent (FCSEMS) placement
offers several advantages such as higher technical success rate and the option of
necrosectomy. The aim of this study was to evaluate the safety and efficacy of EUS
guided drainage of patients with WON by using FCSEMS and intracavitary lavage with
a solution containing hydrogen peroxide and adopting a step-up approach.
Methods A prospective open label study was carried out at a single tertiary care center between
January 2014 and January 2016. Patients with symptomatic WON who underwent EUS guided
drainage followed by FCSEMS placement were included. Primary end points were complete
drainage with improvement in symptoms or major adverse events. Secondary end points
were minor adverse events related to the procedures.
Results A total of 64 patients (mean age 36 years; 52 males) were included. Technical success
was achieved in 100 % of patients and clinical success was achieved in 90.6 %. Complete
drainage was achieved with FCSEMS alone in 18 (28.1 %), FCSEMS with necrosectomy using
lavage in 40 (62.5 %), FCSEMS with percutaneous drainage (PCD) in 5 (7.8 %), and 1
(1.6 %) patient required salvage surgery. The major adverse event was life threatening
bleeding in 3 (4.7 %) patients. Minor adverse events were non-life threatening bleeding
in 2 (3.1 %) patients and stent migration in 3 (4.7 %) patients.
Conclusion EUS guided WON drainage with FCSEMS followed by necrosectomy with lavage using a
solution containing hydrogen peroxide as a step-up approach is a minimally invasive
and effective method with a high technical and clinical success rate. Patients with
solid debris > 40 % need aggressive management.
