A case of walled-off necrosis with systemic lupus erythematosus: Successful treatment with endoscopic necrosectomy

Sato, Satoshi; Takahashi, Hidekuni; Sato, Miki; Yokoyama, Maria; Itoi, Takao; Kawano, Yutaka; Kawashima, Hisashi

doi:10.1016/j.semarthrit.2016.05.003

Cited by 9 publications

(17 citation statements)

References 5 publications

(5 reference statements)

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“…Unfortunately, there is limited data about PEN through SEMS and its clinical outcomes, even if the available evidences are encouraging. In our experience, SEMS-assisted PEN was technically feasible, leading to the resolution of symptoms and stent removal in 20 days, in line with those previously reported [ 5 , 7 , 8 , 22 , 25 ]. Moreover, we did not experience any periprocedural or delayed adverse event, though we do not have to disregard the possible risks of a combined approach (i.e., bleeding, suprainfection, stent migration and stent occlusion due to the LAMS [ 30 ], abdominal pain).…”

Section: Discussionsupporting

confidence: 90%

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

et al. 2021

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Background Endoscopic ultrasound-guided drainage is suggested as the first approach in the management of symptomatic and complex walled-off pancreatic necrosis. Dual approach with percutaneous drainage could be the best choice when the necrosis is deep extended till the pelvic paracolic gutter; however, the available catheter could not be large enough to drain solid necrosis neither to perform necrosectomy, entailing a higher need for surgery. Therefore, percutaneous endoscopic necrosectomy through a large bore percutaneous self-expandable metal stent has been proposed. Case presentation In this study, we present the case of a 61-year-old man admitted to our hospital with a history of sepsis and persistent multiorgan failure secondary to walled-off pancreatic necrosis due to acute necrotizing pancreatitis. Firstly, the patient underwent transgastric endoscopic ultrasound-guided drainage using a lumen-apposing metal stent and three sessions of direct endoscopic necrosectomy. Because of recurrence of multiorgan failure and the presence of the necrosis deeper to the pelvic paracolic gutter at computed tomography scan, we decided to perform percutaneous endoscopic necrosectomy using an esophageal self-expandable metal stent. After four sessions of necrosectomy, the collection was resolved without complications. Therefore, we perform a revision of the literature, in order to provide the state-of-art on this technique. The available data are, to date, derived by case reports and case series, which showed high rates both of technical and clinical success. However, a not negligible rate of adverse events has been reported, mainly represented by fistulas and abdominal pain. Conclusion Dual approach, using lumen apposing metal stent and percutaneous self-expandable metal stent, is a compelling option of treatment for patients affected by symptomatic, complex walled-off pancreatic necrosis, allowing to directly remove large amounts of necrosis avoiding surgery. Percutaneous endoscopic necrosectomy seems a promising technique that could be part of the step-up-approach, before emergency surgery. However, to date, it should be reserved in referral centers, where a multidisciplinary team is disposable.

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Section: Discussionsupporting

confidence: 90%

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

et al. 2021

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“…In total, 52 patients from 15 studies were included in this review [ 37 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] ( Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…The PEN technique [ 37 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] ( Figure 1 A–M) consists of percutaneous puncture of the pancreatic necrotic collection from retroperitoneal, or less frequently, transperitoneal access, under ultrasound or CT guidance. Next, a fully-coated, self-expandable esophageal stent is inserted across the puncture, with its distal end reaching the necrotic collection lumen and its proximal end located outside the patient’s body.…”

Section: Methodsmentioning

confidence: 99%

“…The quality assessment was limited by small amount of data and small number of available articles on this issue (Table 1). In total, 52 patients from 15 studies were included in this review [37,[42][43][44][45][46][47][48][49][50][51][52][53][54][55] (Table 1).…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

“…PEN [ 42 , 43 , 44 , 45 , 46 , 47 , 48 ] consists of the gaining of access to the necrotic collection via percutaneous drainage, followed by broadening of the access and percutaneous placement of a large-diameter self-expandable esophageal stent to facilitate percutaneous insertion of an endoscope into the necrotic collection for endoscopic necrosectomy. Only a few papers [ 37 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] have presented the treatment outcomes of patients with pancreatic necrosis who underwent PEN since the first published description [ 42 , 43 ] of the technique. This paper reviews the available literature to evaluate the efficacy and safety of PEN for the treatment of patients with acute necrotizing pancreatitis.…”

Section: The Strategy Of Minimally Invasive Treatment For Pancreatic ...mentioning

confidence: 99%

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Percutaneous Endoscopic Necrosectomy—A Review of the Literature

Jagielski

Chwarścianek

Piątkowski

et al. 2022

JCM

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In this article, an attempt was made to clarify the role of percutaneous endoscopic necrosectomy (PEN) in the interventional treatment of pancreatic necrosis. A comprehensive review of the current literature was performed to identify publications on the role of PEN in patients with consequences of acute necrotizng pancreatitis. The aim of the study was to review the literature on minimal invasive necrosectomy, with emphasis on PEN using esophageal self-expanding metal stents (SEMS). The described results come from 15 studies after a review of the current literature. The study group comprised 52 patients (36 men and 16 women; mean age, 50.87 (13–75) years) with walled-off pancreatic necrosis, in whom PEN using a self-expandable esophageal stent had been performed. PEN was successfully completed in all 52 patients (100%). PEN complications were observed in 18/52 (34.62%) patients. Clinical success was achieved in 42/52 (80.77%) patients, with follow-up continuing for an average of 136 (14–557) days. In conclusion, the PEN technique is potentially effective, with an acceptable rate of complications and may be implemented with good clinical results in patients with pancreatic necrosis.

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Endoscopic Necrosectomy Through Percutaneous Self-Expanding Metal Stents May Be a Promising Additive in Treatment of Necrotizing Pancreatitis

et al. 2018

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A case of walled-off necrosis with systemic lupus erythematosus: Successful treatment with endoscopic necrosectomy

Cited by 9 publications

References 5 publications

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

Percutaneous Endoscopic Necrosectomy—A Review of the Literature

Endoscopic Necrosectomy Through Percutaneous Self-Expanding Metal Stents May Be a Promising Additive in Treatment of Necrotizing Pancreatitis

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