The cost of endoscopic treatment for walled-off pancreatic necrosis

Neermark, Søren; Rasmussen, Ditlev Nytoft; Rysgaard, Sisse; Gluud, Lise Lotte; Novovic, Srdan; Schmidt, Palle Nordblad

doi:10.1016/j.pan.2019.07.042

Cited by 10 publications

(12 citation statements)

References 11 publications

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“…7,8 Although the treatment of WON has evolved in recent decades to favor endoscopic intervention, which has been shown to reduce complication rates and LOS, WON treatment remains costly. 5,15,32 In our study, the median LOS was 53 days, which is comparable to that reported in similar studies. 8,9 Previous calculations have shown that the mean total cost for a patient treated with endoscopic transmural drainage and necrosectomy was $57,486.…”

Section: Discussionsupporting

confidence: 89%

“…Previous calculations have shown that the mean total cost for a patient treated with endoscopic transmural drainage and necrosectomy was $57,486. Seventy‐five percent of this cost was related to ward care 32 . While protocolized LOS reduction strategies are established in surgery, none of these protocols exists for patients with WON 33 .…”

Section: Discussionmentioning

confidence: 99%

“…Seventy-five percent of this cost was related to ward care. 32 While protocolized LOS reduction strategies are established in surgery, none of these protocols exists for patients with WON. 33 In addition to the clinical aims of reducing mortality and morbidity, future studies should also aim at reducing LOS and costs in the treatment of WON.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes following endoscopic or video‐assisted retroperitoneal management of acute pancreatitis with large (>15 cm) walled‐off pancreatic necrosis: Retrospective, single tertiary center cohort study

Ebrahim

Werge

Hadi

et al. 2022

Digestive Endoscopy

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Objective Acute pancreatitis with walled‐off necrosis (WON) is associated with considerable morbidity and mortality. Previous studies have evaluated outcomes in WON collections of limited size, while data about large WON with long‐term follow‐up are lacking. We aimed to report our experience in managing large WON. Methods Between 2010 and 2020, consecutive patients with large (>15 cm) WON were identified from a prospectively maintained database. Patients with chronic pancreatitis or an index intervention 90 days or more from the debut of symptoms were excluded. We registered clinical and technical outcomes following minimally invasive treatment in WON >15 cm. Follow‐up was a minimum of 1 year. Results Overall, 144 patients with WON >15 cm, with a median age of 60 (interquartile range [IQR] 49–69) years, were included. The median WON size was 19.2 cm (IQR 16.8–22.1). Most patients were treated with endoscopic transluminal drainage (93%). The median length of stay was 53 days (IQR 39–76) and 61 (42%) patients needed intensive care support during their hospital stay. As 143 patients (99%) were managed using endoscopic or video‐assisted retroperitoneal techniques, only one (0.7%) patient needed an open necrosectomy. Procedure‐related adverse events occurred in 10 (7%) patients. Overall, 24 patients (17%) died during admission, all due to multiorgan failure. The median follow‐up was 35 months (IQR 15–63.5). Complete resolution was achieved in all remaining patients. Conclusion Minimally invasive treatment of large WON is feasible, with a minimal need for surgery and acceptable rates of morbidity and mortality.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes following endoscopic or video‐assisted retroperitoneal management of acute pancreatitis with large (>15 cm) walled‐off pancreatic necrosis: Retrospective, single tertiary center cohort study

Ebrahim

Werge

Hadi

et al. 2022

Digestive Endoscopy

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“…At present, the cost of endoscopic treatment for WON differs among studies. The overall cost of LAMS drainage was US $20029-53117, and that of plastic stent drainage was US $15941–57486[ 13 , 23 , 24 ]. Bang et al [ 13 ] reported that the procedural cost of LAMS and plastic stent was US $12155 and US $6609, respectively.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

Liu¹,

Wang

et al. 2020

WJG

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BACKGROUND Endoscopic drainage of walled-off necrosis (WON) is still a challenge due to stent-associated problems. We explored endoscopic gastric fenestration (EGF) as an innovative alternative intervention. AIM To assess the feasibility, efficacy and safety of EGF for WON. METHODS Between March 2019 and March 2020, five patients with symptomatic WON in close contact with the stomach wall were treated by EGF. Endoscopic ultrasound (EUS) was used to select appropriate sites for gastric fenestration, which then proceeded layer by layer as in endoscopic submucosal dissection. Both the stomach muscularis propria and pseudocyst capsule were penetrated. Fenestrations were expanded up to 1.5-3 cm for drainage or subsequent necrosectomy. RESULTS EGF failed in Case 1 due to nonadherence of WON to the gastric wall. EGF was successfully implemented in the other four cases by further refinement of fenestration site selection according to computed tomography, endoscopy and EUS features. The average procedure time for EGF was 124 min (EUS assessment, 32.3 min; initial fenestration, 28.8 min; expanded fenestration, 33 min), and tended to decrease as experience gradually increased. The diameter of the fenestration site was 1.5-3 cm, beyond the caliber of a lumen-apposing metal stent (LAMS), to ensure effective drainage or subsequent necrosectomy. Fenestration sites showed surprising capacity for postoperative self-healing within 1-3 wk. No EGF-related complications were seen. WON disappeared within 3 wk after EGF. In Case 3, another separate WON, treated by endoscopic LAMS drainage, recurred within 4 d after LAMS removal due to stent-related hemorrhage, and resolved slowly over almost 3 mo. No recurrences were observed in the five patients. CONCLUSION EGF is an innovative and promising alternative intervention for WON adherent to the gastric wall. The challenge resides in the gauging of actual adherence and in selecting appropriate fenestration sites.

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“…Until now, DEN has been performed using non-dedicated devices, such as common polypectomy snares, caps, Dormia baskets and retrieval nets [3,4]. The procedure in this fashion is time-consuming, cumbersome, and multiple sessions are usually required, possibly leading to prolonged hospitalization and high costs [5]. Moreover, in cases where a fully covered metal stent has been used for drainage, the numerous passages of the endoscope through the previously placed stent may result in an increased risk for stent dislocation.…”

Section: Introductionmentioning

confidence: 99%

Endorotor-Based Endoscopic Necrosectomy as a Rescue or Primary Treatment of Complicated Walled-off Pancreatic Necrosis. A Case Series

Rizzatti

Rimbaș

Impagnatiello

et al. 2020

JGLD

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Direct endoscopic necrosectomy (DEN) is a cumbersome, time-consuming procedure that can be necessary in cases of infected pancreatic walled-off necrosis (WON) not responding to endoscopic ultrasound (EUS)- guided drainage only. Until now, DEN has been performed with non-dedicated devices, thus requiring multiple, long-lasting sessions to achieve adequate clearance of necrotic content. These results in prolonged hospital stay, increased costs and have potential consequences for patients who must undergo multiple endoscopic interventions under sedation. We report four cases of DEN performed in patients with WON after EUS-guided drainage with the Endorotor system, a new morcellator device specifically designed to perform the procedure.

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The cost of endoscopic treatment for walled-off pancreatic necrosis

Cited by 10 publications

References 11 publications

Clinical outcomes following endoscopic or video‐assisted retroperitoneal management of acute pancreatitis with large (>15 cm) walled‐off pancreatic necrosis: Retrospective, single tertiary center cohort study

Clinical outcomes following endoscopic or video‐assisted retroperitoneal management of acute pancreatitis with large (>15 cm) walled‐off pancreatic necrosis: Retrospective, single tertiary center cohort study

Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

Endorotor-Based Endoscopic Necrosectomy as a Rescue or Primary Treatment of Complicated Walled-off Pancreatic Necrosis. A Case Series

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