Stent‐Assisted Percutaneous Endoscopic Necrosectomy for Infected Pancreatic Necrosis: Technical Report and a Pilot Study

Abstract

Background and aims A variety of minimally invasive techniques have been proposed to replace open surgery for the treatment of infected pancreatic necrosis (IPN). In this study, we evaluate the feasibility and safety of the stent‐assisted percutaneous endoscopic necrosectomy (SAPEN) procedure. Methods Data were collected on all patients who underwent the SAPEN procedure between October 2017 and March 2018. The demographic and clinical characteristics of the study patients were analyzed. A composite primary endpoint of major complications and/or death was used. Three different cases were selected to illustrate different technical aspects of the SAPEN procedure. Results The placement of a percutaneous stent was successful in all of the 23 patients (17 males, six females). IPN was successfully managed in 16/23 (70%) patients, with the need for open surgery in seven patients (30%), with a median of two (range 1–5) SAPEN procedures. No significant procedure‐related complications occurred. Overall 11/23 (48%) patients had a major complication and/or death. Conclusions In conclusion, the SAPEN procedure was effective in treating IPN without adding extra procedural risk. The role and benefits of the SAPEN procedure now need to be demonstrated in larger controlled study.

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

“…Unfortunately, there is limited data about PEN through SEMS and its clinical outcomes, even if the available evidences are encouraging. In our experience, SEMS-assisted PEN was technically feasible, leading to the resolution of symptoms and stent removal in 20 days, in line with those previously reported [ 5 , 7 , 8 , 22 , 25 ]. Moreover, we did not experience any periprocedural or delayed adverse event, though we do not have to disregard the possible risks of a combined approach (i.e., bleeding, suprainfection, stent migration and stent occlusion due to the LAMS [ 30 ], abdominal pain).…”

“…Moreover, endoscopic necrosectomy is mainly performed under moderate conscious sedation and does not require general anesthesia. This is an important advantage also applicable to PEN, which leads to less systemic pro-inflammatory response and minimal collateral damages in already critically ill patients, thereby improving patients’ quality of life [ 12 , 15 , 25 ]. Although not yet addressed, PEN could be cost-effective and future studies should estimate its economic benefits.…”

“…Although some differences regarding the definition of clinical success has emerged, the referred rates ranged from 65 to 89% [ 6 , 8 , 25 ]. The number of PEN sessions needed for WOPN resolution varied widely, from 1 to 7, and the mean time for stent removal ranged between 7 and 37 days (range 3–65) [ 5 – 8 , 19 – 26 ].…”

“…The number of PEN sessions needed for WOPN resolution varied widely, from 1 to 7, and the mean time for stent removal ranged between 7 and 37 days (range 3–65) [ 5 – 8 , 19 – 26 ]. Additional minimally invasive debridement procedures (i.e., percutaneous and/or trans-gastric, even simultaneous) was required in up to 65% of patients [ 8 , 25 ], while 30% of patients (7/23) received additional open surgery as reported by Ke and colleagues [ 25 ], most of them (5/23) because of inadequate endoscopic debridement of necrotic tissue.…”

Necrosectomía endoscópica percutánea en el manejo step-up de walled-off necrosis

“…C) Paredes de cavidad con tejido de granulación do una ruta confiable a través de stent metálico transcutáneo para realizar necrosectomía repetida retroperitoneal o transperitoneal, de acuerdo con la localización y la extensión de tejido necrótico, con posibilidad de realizarlo sin anestesia general, con sedación consciente y "bedside". 9,10…”