Endoscopic Management of Giant Walled-Off Pancreatic Necrosis With a High Risk of Bleeding

Alhasan, Faysal; Hoilat, Gilles J.; Malas, Waddah; Mahmood, Syed K.; Živný, J; Alsayid, Muhammad

doi:10.14309/crj.0000000000000199

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…However, gastrointestinal bleeding, as the most common complication of LAMS therapy, could be induced by direct damage or pseudoaneurysm formation[ 11 ]. A case of large crossing blood vessels within an area of WON has already been reported[ 12 ]. A retrospective study of EUS-mediated drainage with an LAMS showed an increased incidence of pseudoaneurysm bleeding[ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple hidden vessels in walled-off necrosis with high-risk bleeding: Report of two cases

Zhai

et al. 2021

WJCC

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BACKGROUND Walled-off necrosis (WON), as a local complication of acute necrotizing pancreatitis, is difficult to differentiate from pancreatic pseudocysts (PPC). Imaging modalities such as computed tomography show a lower accuracy than endoscopic ultrasound (EUS) in confirming the diagnosis. EUS-guided cystogastrostomy following direct endoscopic necrosectomy has achieved excellent results and has been regarded as a preferred alternative to traditional surgery. However, high-risk bleeding is one of the greatest concerns. CASE SUMMARY Two patients with symptomatic pancreatic fluid collections (PFCs) were admitted to our hospital for EUS-guided lumen-apposing metal stent therapy. The female patient suffered from intermittent abdominal pain and underwent two perioperative CT examinations. The male patient had recurrent pancreatitis and showed a growing PFC. The initial diagnosis was a PPC according to contrast-enhanced CT. However, the evidence of solid contents on EUS prompted revision of the diagnosis to WON. An endoscope was inserted into the cavity, and some necrotic debris and multiple hidden vascular structures were observed. Owing to conservative treatment by irrigation with sterile water instead of direct necrosectomy, we successfully avoided damaging hidden vessels and reduced the risk of intraoperative bleeding. CONCLUSION The application of EUS is helpful for the identification of PFCs. Careful intervention should be conducted for WON with multiple vessels to prevent bleeding.

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Section: Discussionmentioning

confidence: 99%

Multiple hidden vessels in walled-off necrosis with high-risk bleeding: Report of two cases

Zhai

et al. 2021

WJCC

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Pancreatic fluid collections: Clinical manifestations, diagnostic evaluation and management

et al. 2020

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Consensus guidelines on the diagnosis and treatment of pancreatic pseudocyst and walled-off necrosis from a Chinese multiple disciplinary team expert panel

Zhu,

Du,

Wang

et al. 2024

Endosc Ultrasound

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Objective To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis. Methods Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items. Results The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up. Conclusion This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis.

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Endoscopic Management of Giant Walled-Off Pancreatic Necrosis With a High Risk of Bleeding

Cited by 3 publications

References 13 publications

Multiple hidden vessels in walled-off necrosis with high-risk bleeding: Report of two cases

Multiple hidden vessels in walled-off necrosis with high-risk bleeding: Report of two cases

Pancreatic fluid collections: Clinical manifestations, diagnostic evaluation and management

Consensus guidelines on the diagnosis and treatment of pancreatic pseudocyst and walled-off necrosis from a Chinese multiple disciplinary team expert panel

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