Abstract
Background and study aims Infection of pancreatic necrosis is a dreaded complication requiring an intervention.
Nevertheless, the optimal timing of the first intervention is unclear, and consensus
data are sparse. This retrospective two-center study evaluated direct endoscopic necrosectomy
using lumen apposing metal stents in case of proven or suspected infected pancreatic
necrosis in an early stage of the disease.
Patients and methods Forty-nine patients with infected pancreatic necrosis were included. Sequent direct
endoscopic necrosectomies after lumen apposing metal stent insertion (LAMS) were performed
until the resolution of necrosis. In all patients, the first endoscopic intervention
was performed within the first 30 days after first proof of pancreatic necrosis. Primary
outcome parameters were inflammatory activity, days spent in the Intensive Care Unit
(ICU), and mortality.
Results The patient cohort received median 4 necrosectomies (3–5) after a median of 7 days
(3–11) after first proof of pancreatic necrosis. Technical and clinical success were
achieved in 98.3 % and 87.8 %, respectively; the mortality rate was 8.2 %. The median
C-reactive protein level decreased from 241 mg/L (182.9–288.9) before the intervention
to a median of 23.3 mg/L (18–60) after therapy. The median time period in the ICU
was 5 days (3–9).
Conclusions Early endoscopic therapy in the form of direct endoscopic necrosectomy after LAMS
placement within the first 30 days after proof of pancreatic necrosis is effective
and does not result in poor outcome. Our retrospective data suggest that early intervention
before walled-off necrosis is formed is tenable when it is essential due to the patient's
clinical deterioration.