A Protocolized Management of Walled-Off Necrosis (WON) Reduces Time to WON Resolution and Improves Outcomes

Baroud, Serge; Chandrasekhara, Vinay; Storm, Andrew C.; Law, Ryan; Vargas, Eric J.; Levy, Michael J.; Mahmoud, Tala; Bazerbachi, Fateh; Bofill-García, Aliana; Ghazi, Rabih; Maselli, Daniel B.; Martin, John A.; Vege, Santhi Swaroop; Takahashi, Naoki; Petersen, Bret T.; Topazian, Mark D.; Dayyeh, Barham K. Abu

doi:10.1016/j.cgh.2023.04.029

Clinical Gastroenterology and Hepatology

2023

DOI: 10.1016/j.cgh.2023.04.029

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A Protocolized Management of Walled-Off Necrosis (WON) Reduces Time to WON Resolution and Improves Outcomes

Serge Baroud

Vinay Chandrasekhara

Andrew C. Storm

et al.

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Cited by 7 publications

(1 citation statement)

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“…It is likely that other factors are more important determinants of patient outcome than the choice of plastic or metal stents. These include correct case selection, careful preprocedure review of cross-sectional imaging studies, timing of intervention, creation of multiple transluminal drainage sites [10], nutritional support, protocolized rather than symptomatic follow-up [11], a collaborative and multidisciplinary approach, and a commitment to care for and support our patients until they fully recover.…”

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confidence: 99%

Drainage of walled-off necrosis: when can I still use plastic stents?

Topazian

2023

Endosc Int Open

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In many endoscopy units, lumen-apposing metal stents (LAMS) have become standard equipment for endoscopic ultrasound (EUS)-guided drainage of walled-off pancreatic necrosis (WON). Yet before LAMS were available, endoscopists treated WON with much cheaper double pigtail plastic stents (DPPS), and in some practice settings, the cost of a single LAMS can exceed the entire remaining cost of endoscopic care for a patient with WON. The study from Kakadiya and colleagues, published in this issue of the journal [1], adds to a growing body of literature that challenges the routine use of LAMS for drainage of WON. The current study asks: When compared to metal stents, do plastic stents result in inferior patient outcomes?The authors conducted a prospective, randomized, non-inferiority trial comparing LAMS to DPPS in the management of symptomatic WON. Enrolled patients had not undergone prior drainage procedures, and were estimated to have > 20% solid component in their walled-off collections by EUS imaging. Study participants received either a LAMS (15-or 16-mm diameter) or dilation of the transmural tract to 15 mm followed by placement of two DPPS. All drainage procedures were transgastric. Collections were reimaged at 72 hours, 3 weeks, and 3 months, and endoscopic necrosectomy was performed when there was either persistent or new-onset systemic inflammatory response syndrome (SIRS) or organ failure. LAMS were removed at 3 weeks and replaced with plastic stents if there was a persistent collection or a disconnected pancreatic duct. Treatment success, the primary outcome, was defined as both radio-Authors

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confidence: 99%

Drainage of walled-off necrosis: when can I still use plastic stents?

Topazian

2023

Endosc Int Open

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Practical approach to acute pancreatitis: from diagnosis to the management of complications

Padula,

Mauro,

Maggioni

et al. 2024

Intern Emerg Med

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Beyond One-Size-Fits-All: Size-Oriented Criteria for the Step-Up Treatment of Walled-Off Pancreatic Necrosis

Hamada¹,

Tsujimae²,

Nakai³

et al. 2024

Clinical Gastroenterology and Hepatology

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A Protocolized Management of Walled-Off Necrosis (WON) Reduces Time to WON Resolution and Improves Outcomes

Cited by 7 publications

References 29 publications

Drainage of walled-off necrosis: when can I still use plastic stents?

Drainage of walled-off necrosis: when can I still use plastic stents?

Practical approach to acute pancreatitis: from diagnosis to the management of complications

Beyond One-Size-Fits-All: Size-Oriented Criteria for the Step-Up Treatment of Walled-Off Pancreatic Necrosis

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