Health‐related quality of life and long‐term outcomes after endoscopic therapy for walled‐off pancreatic necrosis

Smith, Zachary L.; Gregory, Martin; Elsner, Jeffrey A.; Alajlan, Bader A.; Kodali, Divya; Hollander, Thomas; Sayuk, Gregory S.; Lang, Gabriel; Das, Koushik K.; Mullady, Daniel; Early, Dayna S.; Kushnir, Vladimir

doi:10.1111/den.13264

Cited by 12 publications

(28 citation statements)

References 39 publications

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“…Finally, after endoscopic drainage for WON, patients have a relatively preserved quality of life as assessed using the SF-36 questionnaire; as expected, patients who develop exocrine pancreatic insufficiency had a poorer quality of life as compared to healthy subjects [33] and this latter finding is in accord with a previous study involving patients having chronic pancreatitis associated with exocrine pancreatic insufficiency [34].…”

Section: Endoscopic Treatment: Types Of Stents Which Can Be Used and supporting

confidence: 85%

Walled-Off Necrosis in Acute Pancreatitis: Clinical and Therapeutic Implications

Pezzilli¹

2019

obm hg

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The severe forms of acute pancreatitis may be characterized by the presence of walled-off necrosis (WON), previously called by other names: organized pancreatic necrosis, necroma, pancreatic sequestration, pseudocyst associated with necrosis and subacute pancreatic necrosis. It is defined as a mature, encapsulated collection of pancreatic and/or peripancreatic necrosis that has developed a well-defined inflammatory wall. WON usually occurs more than 4 weeks after the onset of necrotizing pancreatitis. However, it derives from the necrotic pancreatic parenchyma and/or necrotic peripancreatic tissues, and may be sterile or infected, single or multiple, and present at sites distant from the pancreas. In this paper, the current data regarding WON as to its definition, diagnosis and treatment will be narratively reviewed.

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Section: Endoscopic Treatment: Types Of Stents Which Can Be Used and supporting

confidence: 85%

Walled-Off Necrosis in Acute Pancreatitis: Clinical and Therapeutic Implications

Pezzilli¹

2019

obm hg

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“…A recently published retrospective study, which included health-related quality of life data on 41 patients treated endoscopically for WON, found that these patients tended to preserve life quality during FU. 12 Our data on social and working status support this.…”

Section: Discussionsupporting

confidence: 65%

“…This proportion was less than reported earlier in a similar group of patients (43%). 12 The working and marital status remained almost unchanged during the disease course. Regrettably, due to the retrospective design, we were not able to evaluate the quality of life in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of exocrine insufficiency during FU was 18%, which is in accordance with a previous study (17%), 11 while others have reported a considerable higher prevalence (33%). 12 In almost half of the patients needing PERT at discharge, the treatment was discontinued during FU, suggesting a possible reversibility in pancreatic exocrine function. On the other hand, approximately half of the patients needing PERT at FU were not on prescribed medication until after discharge, predominantly within the first year, making evaluation of exocrine function during FU mandatory.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic treatment with transmural drainage and necrosectomy for walled‐off necrosis provides favourable long‐term outcomes on pancreatic function

et al. 2020

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Background and aims Several studies have shown improved short-term outcome with endoscopic transmural drainage and necrosectomy for the treatment of walled-off pancreatic necrosis. However, knowledge on the long-term prognosis after such treatment is limited. The aim of present study was to evaluate long-term outcomes in patients endoscopically treated with transmural drainage and necrosectomy. Methods We retrospectively follow up 125 patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy in 2010–2017. All patients received plastic pigtail stents and nasocystic catheter. Additional external drainage was performed in 41 patients. Main outcomes were survival, pancreatic function, development of co-morbidities, ability to work and social status. Results During a median follow-up of 4.3 years, nine (7%) patients died. Seven deaths were unrelated to pancreatic disease, and two patients died of pancreatic cancer. Twenty-two (18%) patients developed exocrine pancreatic insufficiency. Thirty-six (32%) previous non-diabetics developed endocrine insufficiency. Endoscopic necrosectomy during admission (odds ratio (OR) = 1.28, 95% confidence interval (CI) 1.05–1.56; p = 0.015) and therapy on the main pancreatic duct (OR = 8.08, 95% CI 2.43–26.9; p < 0.001) during follow-up predicted development of exocrine insufficiency. Severity on computed tomography predicted endocrine insufficiency (OR = 1.61, 95% CI 1.24–2.09; p < 0.001). Most patients regained their working capacity and preserved their marital status. Conclusions This study provides robust data on the long-term outcome of patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy. The favourable outcomes on survival, pancreatic function and social status support current recommendations of endoscopic transmural drainage and necrosectomy being the treatment of choice for walled-off pancreatic necrosis.

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“…A retrospective cohort study evaluating the long‐term outcomes and health‐related QOL in these patients demonstrated that the disease‐related mortality and the occurrence of exocrine insufficiency and endocrine insufficiency were 3.7%, 32.5%, and 27.7%, respectively, over a mean follow‐up period of 42.2 months. The health‐related QOL of patients was relatively preserved; however, patients with exocrine insufficiency had a significantly poorer health‐related QOL compared to healthy controls 25 . A recent meta‐analysis showed that complications, such as new‐onset multiple‐organ failure, enterocutaneous fistula/perforations, and pancreatic fistulae, as well as the length of hospitalization were significantly lower following endoscopic interventions compared to those after minimally invasive surgical interventions 26 .…”

Section: Step‐up Approachesmentioning

confidence: 99%

Endoscopic management of walled‐off pancreatic necrosis

Yasuda

Takahashi

2020

Digestive Endoscopy

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Walled‐off pancreatic necrosis (WON) can develop in the late phase of necrotizing pancreatitis. When the WON is accompanied by an infection in the necrotic bed, it becomes a life‐threatening complication. Open necrosectomy with drainage has been the standard treatment; however, it is associated with a significant morbidity and high mortality. Therefore, minimally invasive therapeutic alternatives are in demand. Recently, a new treatment algorithm for necrotizing pancreatitis, known as the step‐up approach, has been proposed. The initial report on it consisted of percutaneous drainage followed by, if necessary, a minimally invasive retroperitoneal necrosectomy. However, the endoscopic step‐up approach, which consists of EUS‐guided transluminal drainage followed by, if necessary, endoscopic necrosectomy, was later introduced. Recent studies have suggested that an endoscopic step‐up approach might be more advantageous than a minimally invasive surgical step‐up approach. A lumen apposing metal stent (LAMS) with a cautery‐enhanced delivery system is currently preferred over the conventional plastic stents for endoscopic interventions, because it decreases the technical difficulty of the procedure and may obviate the need for an adjunctive debridement procedure. However, some recent findings suggest that LAMS could be associated with a higher risk of stent‐related complications than conventional plastic stents, especially in patients with long‐term placement. Therefore, early removal of LAMS at 3 weeks post‐intervention is proposed if the WON is resolved on CT examination. Thus, endoscopic interventions have emerged as a key player in the management of WON. However, multidisciplinary treatment approaches should be considered because the endoscopic approach has limitations in treating complicated WON.

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Health‐related quality of life and long‐term outcomes after endoscopic therapy for walled‐off pancreatic necrosis

Cited by 12 publications

References 39 publications

Walled-Off Necrosis in Acute Pancreatitis: Clinical and Therapeutic Implications

Walled-Off Necrosis in Acute Pancreatitis: Clinical and Therapeutic Implications

Endoscopic treatment with transmural drainage and necrosectomy for walled‐off necrosis provides favourable long‐term outcomes on pancreatic function

Endoscopic management of walled‐off pancreatic necrosis

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