Early experience with cap-assisted endoscopic pancreatic necrosectomy: A technique to enhance safe tissue extraction and decrease interventions

Abstract

Background and study aim Endoscopic treatment of walled-off pancreatic necrosis (WOPN) has been established as an alternative to operative intervention for well selected patients for many years.

Patients and methods A retrospective database of patients who underwent cap-assisted endoscopic necrosectomy of symptomatic or infected WOPN using the assistance of a sterilized banding cap was constructed. All procedures were performed at a single center between January 2017 and June 2018.

Results Eight patients met the inclusion criteria for this study. Contrast computed tomography scan was obtained between the initial percutaneous or trans-gastric access and initial necrosectomy. The WOPN had a median length of 9.5 cm (range 3.2 – 14) and width of 5.3 cm (range 2.8 – 11.6). Median duration of endoscopic debridement was 69 minutes (range 21 – 105). Four of six patients underwent a second debridement with a median duration of 95 minutes (range 16 – 108). No periprocedural adverse events occurred. Follow-up was at 6 months, and there were no additional endoscopic or percutaneous interventions for recurrent pancreatic fluid collections.

Conclusion The technique of cap-assisted necrosectomy can allow for safe and efficient method of endoscopically treating WOPN.

• References

• 1 Peery AF, Crockett SD, Barritt AS. et al. Burden of gastrointestinal, liver, and pancreatic diseases in the united states. Gastroenterology 2015; 149: 1731-1741.e3
• 2 van Dijk SM, Hallensleben NDL, van Santvoort HC. et al. Acute pancreatitis: Recent advances through randomised trials. Gut 2017; 66: 2024-2032
• 3 van Brunschot S, Bakker OJ, Besselink MG. et al. Treatment of necrotizing pancreatitis. Clin Gastroenterol Hepatol 2012; 10: 1190-1201
• 4 van Santvoort HC, Bakker OJ, Bollen TL. et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011; 141: 1254-1263
• 5 Baron TH, Thaggard WG, Morgan DE. et al. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996; 111: 755-764
• 6 Seifert H, Wehrmann T, Schmitt T. et al. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 2000; 356: 653-655
• 7 ASGE Standards of Practice Committee. Muthusamy VR, Chandrasekhara V. et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc 2016; 84: 1-9
• 8 Sarkaria S, Sethi A, Rondon C. et al. Pancreatic necrosectomy using covered esophageal stents: A novel approach. J Clin Gastroenterol 2014; 48: 145-152
• 9 Parikh PY, Pitt HA, Kilbane M. et al. Pancreatic necrosectomy: North american mortality is much lower than expected. J Am Coll Surg 2009; 209: 712-719
• 10 van Brunschot S, van Grinsven J, van Santvoort HC. et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: A multicentre randomised trial. Lancet 2018; 391: 51-58
• 11 Puri N, Graham RA. Cap-assisted necrosectomy: A novel technique increasing safety and efficiency. VideoGIE 2017; 2: 260-261
• 12 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383
• 13 Schmidt PN, Novovic S, Roug S. et al. Endoscopic, transmural drainage and necrosectomy for walled-off pancreatic and peripancreatic necrosis is associated with low mortality--a single-center experience. Scand J Gastroenterol 2015; 50: 611-618
• 14 Dhir V, Adler DG, Dalal A. et al. Early removal of biflanged metal stents in the management of pancreatic walled-off necrosis: A prospective study. Endoscopy 2018; 50: 597-605
• 15 Yasuda I, Nakashima M, Iwai T. et al. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study. Endoscopy 2013; 45: 627-634
• 16 Gardner TB, Coelho-Prabhu N, Gordon SR. et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U. S. series. Gastrointest Endosc 2011; 74: 718-726