Mo1334 TIME FOR CHANGING OF GUARD: FROM MINIMALLY INVASIVE SURGERY TO ENDOSCOPIC DRAINAGE FOR MANAGEMENT OF WALLED-OFF PANCREATIC NECROSIS

Khan, Muhammad Ali; Kahaleh, Michel; Tyberg, Amy; Khan, Zubair; Hammad, Tariq; Sofi, Aijaz; Shrestha, Shreesh; Ismail, Mohammad K.; Tombazzi, Claudio; Baron, Todd H.

doi:10.1016/j.gie.2018.04.1984

Cited by 6 publications

(8 citation statements)

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“…Since its introduction, EUS-guided drainage has increasingly become adopted as the procedure of choice for symptomatic mature pancreatic fluid collections. [6][7][8][9][10][11][12] Despite high clinical success rates using the traditional cystoenterostomy technique for pseudocyst drainage, clinical success was lower for drainage of WON due to stent occlusion and superimposed infection which was believed to be primarily due to the need for endoscopic debridement. 13,14 Additional approaches such as the multiple transluminal gateway technique were developed to address this issue.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Endoscopic ultrasound-guided cystoenterostomy with DEN is increasingly used for endoscopic management of WON. [6][7][8][9] However, there is limited data directly comparing LAMS cystoenterostomy to traditional cystoenterostomy with DP drainage. In this study, we aimed to compare clinical outcomes and adverse events between LAMS cystoenterostomy and traditional cystoenterostomy with DP drainage in the endoscopic management of WON.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study Evaluating Lumen Apposing Metal Stents Versus Double Pigtail Plastic Stents for Treatment of Walled-Off Necrosis

Young

Jirapinyo

et al. 2020

Pancreas

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Objectives: Lumen-apposing metal stents (LAMS) are increasingly used for direct endoscopic necrosectomy (DEN) in the management of walled-off necrosis (WON). We compared LAMS and traditional cystoenterostomy in the management of WON.Methods: Retrospective analysis of patients who underwent DEN for management of WON. Primary outcome was rate of WON resolution. Secondary outcomes included technical and clinical success, time and number of procedures until resolution, requirement for alternative therapy, recurrence, and adverse events.Results: One hundred twelve patients underwent DEN with LAMS (n = 34) or traditional cystoenterostomy (n = 78). Mean WON size was 90.2 × 60.1 mm, and 61.8% had infected necrosis. Overall WON resolution was similar between LAMS and traditional cystoenterostomy (94.1% vs 92.1%, P = 0.510), with similar number of procedures until resolution (1.5 vs 1.5, P = 0.871). The LAMS were associated with faster resolution (86.9 vs 133.6 days, P = 0.038), lower recurrence (6.3% vs 23.1%, P = 0.032), and decreased requirement for surgery (0% vs 12.8%, P = 0.031) compared to traditional cystoenterostomy, but higher adverse event rates (41.2% vs 7.7%, P < 0.001).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Study Evaluating Lumen Apposing Metal Stents Versus Double Pigtail Plastic Stents for Treatment of Walled-Off Necrosis

Young

Jirapinyo

et al. 2020

Pancreas

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“…Another recent meta-analysis conducted by Khan et al [35] on two randomized trials and four observational studies, involving 641 patients with infected or symptomatic WOPN compared safety and clinical outcomes of minimally invasive surgical intervention to endoscopic intervention. Endoscopic intervention was associated with lower mortality, less new onset organ failure, enterocutaneous fistula or perforation of a visceral organ, pancreatic fistula and shorter hospital/ICU stay.…”

Section: Indication For Intervention In Pncsmentioning

confidence: 99%

Direct Endoscopic Necrosectomy: Timing and Technique

Pinto

Bellizzi²,

Badas

et al. 2021

Medicina

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Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this narrative review is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.

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“…A systematic review has recently been carried out to compare the safety of endoscopic drainage (ED) with minimally invasive surgical necrosectomy (MISN) for the management of WON [35] involving 641 patients (326 ED and 315 MISN). The rates of mortality for ED and MISN were 8.5% and 14.2%, respectively.…”

Section: Surgical Optionmentioning

confidence: 99%

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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Mo1334 TIME FOR CHANGING OF GUARD: FROM MINIMALLY INVASIVE SURGERY TO ENDOSCOPIC DRAINAGE FOR MANAGEMENT OF WALLED-OFF PANCREATIC NECROSIS

Cited by 6 publications

References 0 publications

Comparative Study Evaluating Lumen Apposing Metal Stents Versus Double Pigtail Plastic Stents for Treatment of Walled-Off Necrosis

Comparative Study Evaluating Lumen Apposing Metal Stents Versus Double Pigtail Plastic Stents for Treatment of Walled-Off Necrosis

Direct Endoscopic Necrosectomy: Timing and Technique

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

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