Trans‐gastric Endoscopic Drainage Using a Large Balloon for Pancreatic Necrosis and Abscess – Two Case Reports

Abstract

Reports on endoscopic treatment for pancreatic necrosis and pancreatic abscess have occasionally been published in recent years. Single treatments using endoscopic transpapillary or transumural drainage were originally used, but these were frequently changed to surgical therapy. In recent years, attempts have been made, such as the use of a combination of transmural and transpapillary approaches, the balloon dilatation of the cystgastrostoma, and a daily endoscopic necrosectomy and saline solution lavage, and the treatment results have thus been improved, even though the number of cases is low. We performed transmural endoscopic ultrasonography (EUS)-guided drainage without a necrosectomy in two cases with pancreatic necrosis and abscess, and treated cases in which a continuous closed lavage using a tube with a large diameter was effective, and we herein report our findings.

Asian consensus statements on endoscopic management of walled‐off necrosis. Part 2: Endoscopic management

“…We reviewed studies of endoscopic necrosectomy, including case reports, case series, and previous review articles . Data on complications were collected retrospectively.…”

“…Data on complications were collected retrospectively. Finally, we analyzed a total of 37 articles and 633 patients after excluding unclear data on complication rates. The rates of morbidity and mortality associated with endoscopic necrosectomy were 27.3% (173/633) and 4.4% (28/633), respectively.…”

“…On the other hand, the success rate of endoscopic necrosectomy is not well known because of the lack of a standard definition of treatment success. We reviewed 38 published articles that reported treatment success, and a total of 697 patients treated with endoscopic necrosectomy were analyzed . When we define the resolution of the WON cavity as “treatment success,” the success rate was 82.6% (576/697).…”

“…41,46,50,53,57,58,61,72,73 Data on complications were collected retrospectively. Finally, we analyzed a total of 37 articles 7,[15][16][17]19,23,28,29,31,[42][43][44][45]48,49,51,52,[54][55][56]59,60,[62][63][64][65][66][67][68][69][70][71]74,75,[78][79][80] and 633 patients after excluding unclear data on complication rates. The rates of morbidity and mortality associated with endoscopic necrosectomy were 27.3% (173/633) and 4.4% (28/633), respectively.…”

“…We reviewed 38 published articles that reported treatment success, and a total of 697 patients treated with endoscopic necrosectomy were analyzed. 7,[15][16][17]19,23,28,29,31,36,42,43,45,[47][48][49]51,52,[54][55][56]59,60,[63][64][65][66][67][68][69][70][71][74][75][76][77][78][79] When we define the resolution of the WON cavity as "treatment success," the success rate was 82.6% (576/697). In addition, the recurrence rate after endoscopic necrosectomy was retrospectively studied.…”