Direct Endoscopic Necrosectomy: Timing and Technique

Pinto, Sérgio Wyton Lima; Bellizzi, Saverio; Badas, Roberta; Canfora, Maria Laura; Loddo, Erica; Spada, Simone; Khalaf, Kareem; Fugazza, Alessandro; Bergamini, Silvio

doi:10.3390/medicina57121305

Cited by 11 publications

(8 citation statements)

References 97 publications

(223 reference statements)

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“…11 As use of air insufflation is associated with risk of gas embolism, ETN is performed using carbon dioxide. 41 Forward viewing flexible gastroscopes are used for performing necrosectomy. The diagnostic scopes, although have advantage of flexibility, are not suitable for necrosectomy because of small working channel limiting the suctioning ability as well as passage of large diameter accessories.…”

Section: Chemical Debridementmentioning

confidence: 99%

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Endoscopic treatment of pancreatic necrosis: Still searching for perfection!

Rana

2023

J of Gastro and Hepatol

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Over last few years, there has been a paradigm shift in the management of infected pancreatic necrosis with endoscopic and minimally invasive "step-up" management approach replacing open surgical necrosectomy. Because of being associated with reduced occurrence of new onset multi-organ failure, external pancreatic fistulae, shorter hospital stay, lower costs, and better quality of life compared with minimally invasive surgical approach, endoscopic "step-up" management approach is the preferred intervention for endoscopically accessible pancreatic necrotic collections at expert centers with endoscopic expertise. Development of lumen apposing metal stents and improvised accessories for interventional endoscopic ultrasound has revolutionized the endoscopic management of pancreatic necrosis making it more effective and safer. Despite these promising developments, endoscopic transluminal necrosectomy (ETN) remains the Achilles heel. Lack of dedicated endoscopic accessories, poor endoscopic visualization within the necrotic cavity, limited diameter of the instrument channel of the endoscope that is a significant impediment to remove large amount of necrotic material, and uncertain ability to avoid vessels and vital structures in the necrotic cavity are important limitations during endoscopic necrosectomy. Recent devices and solutions including use of cap assisted necrosectomy, over the scope grasper and powered endoscopic debridement device are welcome steps in our pursuit for an ideal, safer, and efficacious ETN device. This review will discuss recent advances as well as challenges in the endoscopic management of pancreatic necrosis.

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Section: Chemical Debridementmentioning

confidence: 99%

“…As use of air insufflation is associated with risk of gas embolism, ETN is performed using carbon dioxide 41 . Forward viewing flexible gastroscopes are used for performing necrosectomy.…”

Section: Chemical Debridementmentioning

confidence: 99%

Endoscopic treatment of pancreatic necrosis: Still searching for perfection!

Rana

2023

J of Gastro and Hepatol

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“…It has a fixed outer cannula with a hollow inner cannula that can be set at rotation speeds of 1000 (low) or 1700 (high) revolutions per min. Typically, as outlined in the electronic control console, cutting ranges from 2-4 mm of tissue per sec [ 67 ]. The necrotic tissue is sucked into the catheter using negative pressure and cut by the rotating blade from the inner cannula.…”

Section: Mechanical Debridementmentioning

confidence: 99%

Endoscopic management of pancreatic walled-off necrosis

Ramai¹

2023

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Pancreatic walled-off necrosis (WON) is a complication of severe pancreatitis. Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collections. Endoscopy offers a minimally invasive approach when compared to surgical drainage. Today, endoscopists may choose to use self-expanding metal stents, pigtail stents, or lumen-apposing metal stents to facilitate drainage of fluid collections. Current data suggest that all 3 approaches yield similar outcomes. It was previously thought that drainage should be performed 4 weeks from the initial event of pancreatitis, theoretically allowing the capsule to mature. However, current data show that both early (<4 weeks) and standard (≥4 weeks) endoscopic drainage are comparable. Herein, we provide an up-to-date state-of-the-art review of the indications, techniques, innovations, outcomes, and future perspectives following drainage of pancreatic WON.

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“…With the advent of LAMS and technological advances in its deployment, large prospective RCTs are needed to standardize the criteria for early or delayed DEN for better outcomes in management of symptomatic or infected WON. Most experts recommend an interval of 2–3 days between stent placement and DEN, depending upon clinical condition of patient, size of cavity, amount of solid debris, and degree of adhesion to the adjacent wall [ 61 ].…”

Section: Timing Of Denmentioning

confidence: 99%