Pancreatic Necrosectomy Using Covered Esophageal Stents

Sarkaria, Savreet; Sethi, Amrita; Rondón, Carlos; Lieberman, Michael D.; Srinivasan, Indu; Weaver, Kristen R.; Turner, Brian G.; Sundararajan, Sri Hari; Berlin, David; Gaidhane, Monica; Rolshud, Daniil; Widmer, Jessica L.; Kahaleh, Michel

doi:10.1097/mcg.0b013e3182972219

Cited by 55 publications

(44 citation statements)

References 11 publications

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“…A summary of studies reporting the use of CSEMS in 56 patients with pancreatic abscess or infected WONs is shown in Table 5 20,23,27,28,30,31,38,40–43. The technical success rate (100%, 57/57 pancreatic abscess or WONs) and the pancreatic abscess or infected WON complete resolution rate (87.8%, 43/49 pancreatic abscess or infected WONs) were high similarly to PPs.…”

Section: Clinical Impact Of Csems For Pfc Treatmentmentioning

confidence: 96%

Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

Kawakami¹,

Itoi²,

Sakamoto³

2014

Gut Liver

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Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris.

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Section: Clinical Impact Of Csems For Pfc Treatmentmentioning

confidence: 96%

Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

Kawakami¹,

Itoi²,

Sakamoto³

2014

Gut Liver

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“…The first reported case of WOPN drainage using an esophageal FCSEMS was published by Antillon et al [96] . Sarkaria et al [97] published results of 17 patients who underwent WOPN drainage with placement of an esophageal stent, 88% of whom demonstrated complete resolution with an average of 5 endoscopic sessions and 2 of whom ultimately required surgical intervention. No major complications were reported.…”

Section: Fully-covered Self-expanding Metal Stentsmentioning

confidence: 99%

“…Sarkaria et al [97] , 2014 17 EUS-guided drainage Fully covered esophageal selfexpandable metallic stents 88% 88% Perforation during tract dilation (1) Shah et al [61] , 2015 33 EUS-guided drainage Lumen-apposing, covered, selfexpanding metal stent; Axios 91% 93% Abdominal pain (n = 3), spontaneous stent migration, back pain (n = 1), access-site infection, and stent dislodgement (n = 1) Walter et al [63] , 2015 61 EUS-guided drainage Axios 93% 98% stent migration (n = 3), stent dislodgement during necrosectomy (n = 3), stent removal during surgery (n = 2), or refusal by the patient (n = 2) Mukai et al [99] , 2015 2 EUS-guided drainage/ Direct endoscopic necrosectomy novel flared-type biflangedmetal stent 100% 100% There was 1 psuedocyst recurrence in cystogramy Rinninella et al [64] , 2015 18 EUS-guided drainage Lumen-apposing, selfexpanding metal stent (Axios)…”

Section: % 100%mentioning

confidence: 99%

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Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

Self Cite

164

154

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Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting. However, with improving pathophysiologic under standing and improving diagnostic tools, it became clear that a more detailed organizational system was required. More specifically, one that distinguished between collections containing fluid alone vs those arising from necrosis and/or containing solid components. As such, a new classification system was developed known as the revised Atlanta criteria [4] . Similar to the original Atlanta Criteria, PFCs are classified as acute (< 4 wk after the pancreatitis episode) or chronic (> 4 wk after the pancreatitis episode). However, in the revised criteria, both acute and chronic collections are further subdivided based on the presence of necrosis within the collection. Acute collections are divided into: acute peripancreatic fluid collections (APFC) and acute necrotic collections (ANC); chronic fluid collections are divided into: pseudocysts or walledoff pancreatic necrosis (WOPN). These new classifications are important because the treatment and management varies depending on the type of collection. ENTERAL FEEDINGThe first step in the management of any PFC is ensuring adequate nutritional support. In mild to moderate acute pancreatitis, oral feeding can be initiated when...

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“…This technique is especially important following transgastric puncture and dilation as it may be challenging to identify the puncture site among gastric folds. Another option is to place a large-bore (16-23 mm mid-body diameter) SEMS across the dilated gastric or duodenal wall [29][30][31][32][33]. Transmural placement of largediameter, covered esophageal SEMS facilitates additional DEN procedures and avoids the need for repeated balloon dilation prior to each intervention [30].…”

Section: Procedural Techniquementioning

confidence: 99%

Endoscopic management of pancreatic pseudocysts and necrosis

Law

Baron

2014

Expert Review of Gastroenterology & Hepatology

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Over the last several years, there have been refinements in the understanding and nomenclature regarding the natural history of acute pancreatitis. Patients with acute pancreatitis frequently develop acute pancreatic collections that, over time, may evolve into pancreatic pseudocysts or walled-off necrosis. Endoscopic management of these local complications of acute pancreatitis continues to evolve. Treatment strategies range from simple drainage of liquefied contents to repeated direct endoscopic necrosectomy of a complex necrotic collection. In patients with chronic pancreatitis, pancreatic pseudocysts may arise as a consequence of pancreatic ductal obstruction that then leads to pancreatic ductal disruption. In this review, we focus on the indications, techniques and outcomes for endoscopic therapy of pancreatic pseudocysts and walled-off necrosis.

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Pancreatic Necrosectomy Using Covered Esophageal Stents

Abstract: Endoscopic necrosectomy with covered esophageal metal stents is a safe and successful treatment option for infected pancreatic necrosis.

Cited by 55 publications

References 11 publications

Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

Management of pancreatic fluid collections: A comprehensive review of the literature

Endoscopic management of pancreatic pseudocysts and necrosis

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