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DOI: 10.1055/s-0039-1681722
IMMEDIATE DIRECT ENDOSCOPIC NECROSECTOMY FOLLOWING ONE-STEP EXCHANGE FREE EUS-GUIDED DRAINAGE OF WALLED OFF PANCREATIC NECROSIS
Publication History
Publication Date:
18 March 2019 (online)
Aims:
EUS-guided drainage with Lumen Apposing Metal Stents (LAMS) and direct endoscopic necrosectomy (DEN) is an effective mininvasive treatment of infected or symptomatic WOPNs. It revealed a lower complication and mortality rate compared to surgery or percutaneous approach. The aim of our study is to evaluate efficacy and safety of EUS-guided drainage of infected WOPNs with a LAMS and immediate DEN in a consecutive cohort of patients.
Methods:
All consecutive patients with infected or symptomatic WOPN from February 2014 to June 2018 were retrospectively reviewed. All patients underwent electrocautery-enhanced LAMS (EC-LAMS) placement with the “one-step exchange-free” technique. Immediate DEN with hydrogen peroxide irrigation was performed following stent placement in all patients. DEN was then repeated until resolution of the WOPN. The primary outcomes were to evaluate survival rate and clinical success. Secondary outcomes included: technical success, adverse events (AEs) and number of procedures per patient.
Results:
45 patients were treated in the study period. Clinical success was of 88,8%. Survival rate was 91 and 88,8% at 1 and 3 months, respectively. Technical success was achieved in 97,7% of patients and no procedure-related AEs occurred. Mean number of procedure per patient was 3,7. In the follow-up time (mean of 687 days) pseudocyst formation was observed in two cases, successfully treated by endoscopic therapy.
Conclusions:
Immediate DEN following EUS-guided one-step exchange-free EC-LAMS placement is an effective and safe treatment for infected or symptomatic WOPNs.