Evaluation of hydrogen peroxide-assisted endoscopic ultrasonography-guided necrosectomy in walled-off pancreatic necrosis

Abstract

Hydrogen peroxide is a liquid that functions in mechanical removal of the necrotic tissue via the elimination of tissue debris. In this study, we aimed to evaluate the effectiveness of the use of hydrogen peroxide in necrosectomy treatment of walled-off pancreatic necrosis. Records of 24 patients who were diagnosed with pancreatic necrosis or walled-off pancreatic necrosis and underwent endoscopic necrosectomy (EN) were retrospectively assessed. Patients were divided into 2 groups; hydrogen peroxide used for treatment or not used, and these 2 groups were compared. A total of 24 patients underwent endoscopic intervention for walled-off pancreatic necrosis. Procedural success was comparable between the 2 groups. During the post-procedural follow-up, the duration of the hospital stay, recurrence, and complication rates were found to be similar in both groups. The mean number of the endoscopic interventions was significantly lower in the hydrogen peroxide group (4.2 ± 1.4 vs 6.1 ± 4.2; P = .01). The use of hydrogen peroxide for EN in walled-off pancreatic necrosis patients seems to have similar efficiency and safety. However, it can be said that the use of hydrogen peroxide could reduce the number of endoscopic procedures.

Time to think prime times for treatment of necrotizing pancreatitis: Pendulum conundrum

“…Irrigation may facilitate the washout of infectious components within the cavity and accelerate PFC resolution. However, the study results have been inconsistent in terms of its effectiveness, 36,[47][48][49][50][51][52] and bacteremia may be provoked via the advertently increased intracystic pressure. Therefore, the starting time of irrigation should be determined with caution.…”

Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis: Progress and challenges

“…In several previous studies, hydrogen peroxide has proven effective and safe in reducing debridements, even making external irrigation unnecessary in selected IPN patients[ 82 , 94 ]. Hydrogen peroxide has the advantage of healing INP by stimulating granulation and fibrosis, and foams produced by hydrogen peroxide in contact with organic tissue help remove the attached necrotic debris[ 95 ]. However, its operation time and treatment course to achieve equal clinical efficacy with routine debridement seem prolonged[ 96 ], and this technique's optimal procedure and concentration remain to be further studied[ 94 ].…”

Direct Endoscopic Necrosectomy: Timing and Technique

“…Hydrogen peroxide (H 2 O 2 ) is a colorless which rapidly dissociates into oxygen and H 2 O when in contact with organic tissues, producing a soft foam that helps removing materials attached to the tissue, including necrotic debris [70,71]. Furthermore, it seems help wounds healing by stimulating granulation and fibrosis [72]. In order to use its healing and chemical debridement properties, it has often been used as aid in DEN, despite lack of properly designed clinical trials to assess its efficacy, AEs, and technical aspects in such field [62].…”

“…For this reasons, current international guidelines suggest restraint regarding H 2 O 2assisted DEN [13,14]. Many series and comparative trials, published both prior to and after the publication of the guidelines, reported a high technical and clinical success of H 2 O 2assisted DEN, a reduced number and duration of DEN sessions, with sometimes no need at all for mechanical debridement, and an AEs profile and rate similar to non-H 2 O 2 -assisted DEN [70,[72][73][74].…”

“…To the best of our knowledge no case of such AE has been reported in the published H 2 O 2 -assisted DEN series. Some authors suggest that H 2 O 2 -induced gas embolism may be favored by its use into closed and semi-closed cavities, where oxygen release may cause an increase of the cavity pressure, facilitating gas passage into blood vessels [72,82]. Low flow saline irrigation may be a safer alternative practice to help performing DEN.…”