Percutaneous direct endoscopic pancreatic necrosectomy

作     者：Manoj A Vyawahare Sushant Gulghane Rajkumar Titarmare Tushar Bawankar Prashant Mudaliar Rahul Naikwade Jayesh M Timane 

作者机构：Department of Medical GastroenterologyAmerican Oncology Institute at Nangia Specialty HospitalNagpur 440028MaharashtraIndia Department of Internal Medicine and Critical CareAmerican Oncology Institute at Nangia Specialty HospitalMIDC HingnaNagpur 440028MaharashtraIndia Department of AnaesthesiologyAmerican Oncology Institute at Nangia Specialty HospitalMIDC HingnaNagpur 440028MaharashtraIndia Department of RadiologyAmerican Oncology Institute at Nangia Specialty HospitalMIDC HingnaNagpur 440028MaharashtraIndia Department of SurgeryAmerican Oncology Institute at Nangia Specialty HospitalMIDC HingnaNagpur 440028MaharashtraIndia 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2022年第14卷第8期

页      面：731-742页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Infected pancreatic necrosis Direct endoscopic necrosectomy Percutaneous endoscopic necrosectomy Sinus tract endoscopy Stent-assisted percutaneous direct endoscopic necrosectomy 

摘      要：Approximately 10%-20% of the cases of acute pancreatitis have acute necrotizing pancreatitis. The infection of pancreatic necrosis is typically associated with a prolonged course and poor prognosis. The multidisciplinary, minimally invasive “step-up approach is the cornerstone of the management of infected pancreatic necrosis(IPN). Endosonography-guided transmural drainage and debridement is the preferred and minimally invasive technique for those with IPN. However, it is technically not feasible in patients with early pancreatic/peripancreatic fluid collections(PFC)( 2-4 wk) where the wall has not formed;in PFC in paracolic gutters/pelvis;or in walled off pancreatic necrosis(WOPN) distant from the stomach/duodenum. Percutaneous drainage of these infected PFC or WOPN provides rapid infection control and patient stabilization. In a subset of patients where sepsis persists and necrosectomy is needed, the sinus drain tract between WOPN and skin-established after percutaneous drainage or surgical necrosectomy drain, can be used for percutaneous direct endoscopic necrosectomy(PDEN). There have been technical advances in PDEN over the last two *** esophageal fully covered self-expandable metal stent, like the lumen-apposing metal stent used in transmural direct endoscopic necrosectomy, keeps the drainage tract patent and allows easy and multiple passes of the flexible endoscope while performing PDEN. There are several advantages to the PDEN procedure. In expert hands, PDEN appears to be an effective, safe, and minimally invasive adjunct to the management of IPN and may particularly be considered when a conventional drain is in situ by virtue of previous percutaneous or surgical intervention. In this current review, we summarize the indications, techniques, advantages, and disadvantages of PDEN. In addition, we describe two cases of PDEN in distinct clinical situations, followed by a review of the most recent literature.