Despite great progress in acute pancreatitis (AP) treatment over the last 30 years, treatment of the consequences of acute necrotizing pancreatitis (ANP) remains controversial. While numerous reports on minimally invasive treatment of the consequences of ANP have been published, several aspects of interventional treatment, particularly endoscopy, are still unclear. In this article, we attempt to discuss these aspects and summarize the current knowledge on endoscopic therapy for pancreatic necrosis. Endotherapy has been shown to be a safe and effective minimally invasive treatment modality in patients with consequences of ANP. The evolution of endoscopic techniques has made endoscopic drainage more effective and reduced the use of other minimally invasive therapies for pancreatic necrosis.

MPD disruption occurs in the majority of patients with WON. Partial disruption of the MPD is more frequent than complete disruption of the duct. This study conducted on a large group of patients demonstrated that prosthesis insertion into the MPD in patients with disruption of the MPD in the course of ANP is one of the key elements in endoscopic treatment of WON. Passive transpapillary drainage is an effective method of treating MPD disruptions, which improves long-term outcomes of endoscopic treatment in patients with WON.

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IntroductionWalled-off pancreatic necrosis (WOPN) often coexists with disruption of the main pancreatic duct that manifests as a leak of contrast medium into the necrotic collection during endoscopic retrograde pancreatography.AimTo assess the efficacy and safety of treatment of patients with symptomatic WOPN and disruption of the main pancreatic duct, who underwent endoscopic transpapillary drainage as the only access to the necrosis cavity.Material and methodsIn 22 patients with symptomatic WOPN, active endoscopic transpapillary drainage was performed. During endoscopic retrograde pancreatography (ERP), partial disruption of the main pancreatic duct was observed in 14 patients and complete disruption in 8 patients. After the active drainage was finished, a transpapillary pancreatic stent was inserted into the main pancreatic duct, which was later exchanged after 6, 12 and 24 months or when no extravasation of contrast from the pancreatic duct was observed. The results of treatment and complications were compared retrospectively.ResultsThe mean duration of active drainage was 22 (range: 7–94) days. Complications of endotherapy occurred in 3/22 patients. The mean time of the main pancreatic duct stenting was 304 (range: 85–519) days. Success of endoscopic treatment of WOPN and pancreatic duct disruption was achieved in 20/22 patients. During a 1-year follow-up, recurrence of the collection was noted in 4/20 patients. Long-term success was achieved in 16/22 patients.ConclusionsIn patients with WOPN who cannot undergo transmural drainage when there is a communication between the necrotic collection and the main pancreatic duct, transpapillary access may be an effective and safe method of treatment.

Background Endotherapy is a common method of treatment in patients with symptomatic walled-off pancreatic necrosis (WOPN). The aim of this study is to indicate the potential therapeutic possibilities created by the combination of several new endoscopic techniques and the evaluation of their efficacy in the treatment of WOPN. Methods The retrospective analysis of results and complications in the group of 101 patients, who underwent endoscopic treatment of symptomatic WOPN between years 2011 and 2015. Results Endoscopic treatment was started in 101 patients (71 men, 30 women; mean age 50.97 years) with symptomatic WOPN. Single transluminal gateway technique (SGT) was used in 93/101 (92.08%) patients. SGT in combination with multiple transluminal gateway technique (MTGT) was exploited in 4/93 (4.30%) patients, while in combination with single transluminal gateway transcystic multiple drainage (SGTMD) in 22/93 (23.66%) patients. Transpapillary access was used in 11/101 (10.89%) patients. 20/101 (19.80%) patients underwent percutaneous drainage. Fluoroscopy-guided endoscopic necrosectomy was performed in 19/101 (18.81%) patients. The combinations of endoscopic techniques depended on the extent of necrosis. Procedure-related complications occurred in 16/101 (15.84%) patients. The mortality rate was 0.99% (1/101 patient). Therapeutic success was achieved in 99/101 (98.02%) patients. The long-term success of endoscopic treatment was achieved in 97/101 (96.04%) patients with symptomatic WOPN. Conclusions Application of new endoscopic techniques in the treatment of the patients with symptomatic WOPN significantly improves the efficiency of endotherapy with an acceptable amount of complications.