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Percutaneous endoscopic necrosectomy for walled-off necrosis in the retroperitoneal space of the elderly:A case report

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World Journal of Clinical Cases 2023年第24期11卷 5736-5741页

作者： Kentaro Sato Goro Shibukawa Kenta Ueda Yuki Nakajima Kazutomo Togashi Hiromasa Ohira Department of Gastroenterology Aizu Medical Center Fukushima Medical UniversityAizuwakamatsu 969-3492FukushimaJapan Department of Gastroenterology Fukushima Medical University School of MedicineFukushima 960-1295FukushimaJapan

BACKGROUND Walled-off necrosis(WON)is a late complication of acute pancreatitis possibly with a fatal *** for WON spreading to the retroperitoneal space,percutaneous endoscopic necrosectomy(PEN)can be an alternate approach to surgical necrosectomy,particularly for the older individuals or patients with poor condition because of *** SUMMARY An 88-year-old man was admitted to our hospital with a *** retrograde cholangiopancreatography(ERCP)was performed to improve jaundice;however,post-ERCP pancreatitis *** inflammation of pancreatitis spread widely from the right retroperitoneal cavity to the pelvis,and WON was formed 4 wk later.A percutaneous drainage tube was placed into the WON under computed tomography ***,the drainage did not ameliorate clinical symptoms including fever,which assured less invasive necrosectomy.A metallic stent for the upper gastrointestinal(GI)tract was placed from the percutaneous drainage *** upper GI endoscope was inserted into the inside of the WON through the metallic stent,and the necrotic tissues were bluntly removed with a snare *** times of these necrosectomies resulted in the near-complete removal of necrotic *** procedures consequently abated his fever and remarkable improvement in blood *** PEN for WON occurring in the retroperitoneal space was safe and effective for very old individuals.

关键词： Walled-off necrosis Percutaneous drainage endoscopic necrosectomy Post endoscopic retrograde cholangiopancreatography pancreatitis Elderly Case report

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endoscopic fibrin glue injection for closure of pancreatocutaneous fistula following transgastric endoscopic necrosectomy

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World Journal of Gastroenterology 2008年第39期14卷 6093-6095页

作者： Ji Woong Jang Do Hyun Park Sung-Hoon Moon Sang Soo Lee Dong Wan Seo Sung Koo Lee Myung-Hwan Kim Division of Gastroenterology Department of Internal MedicineUniversity of Ulsan College of MedicineAsan Medical CenterSeoul 138-736South Korea

Transgastric endoscopic necrosectomy has been recently introduced as the effective and alternative management of infected pancreatic necrosis and pancreatic abscess. However,up to 40% of patients who undergo endoscopic necrosectomy may need an additional percutaneous approach for subsequent peripancreatic fluid collection or non-resolution of pancreatic necrosis. This percutaneous approach may lead to persistent pancreatocutaneous fistula,which remains a serious problem and usually requires prolonged hospitalization,or even open-abdominal surgery. We describe the first case of pancreatocutaneous fistula and concomitant abdominal wall defect following transgastric endoscopic necrosectomy and percutaneous drainage,which were endoscopically closed with fibrin glue injection via the necrotic cavity.

关键词： Fibrin glue Pancreatocutaneous fistula Infected pancreatic necrosis Pancreatic abscess endoscopic necrosectomy

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endoscopic pancreatic necrosectomy in the United States-Mexico border:A cross sectional study

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World Journal of Gastrointestinal Endoscopy 2020年第5期12卷 149-158页

作者： Antonio Mendoza Ladd Mohammad Bashashati Alberto Contreras Onyedika Umeanaeto Alejandro Robles Department of Internal Medicine Division of GastroenterologyTexas Tech University Health Sciences CenterPaul L Foster School of MedicineEl PasoTX 79905United States Department of Internal Medicine Texas Tech University Health Sciences CenterPaul L Foster School of MedicineEl PasoTX 79905United States

BACKGROUND A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy(DEN) for pancreatic walled-off necrosis(WON).However, significant technical heterogeneity still exists among *** To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous *** Medical records of patients with WON who underwent DEN from September2016-May 2019 were queried for the following information: Age, gender,ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events(AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent(LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months(mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables,frequency and proportion for categorical variables, and median and range for interval *** A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance,dilated the same day of deployment and removed after a mean of 27 ± 11 *** cross-sectional imaging immediately after drainage was not *** mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis(2), stent migration(1), stent maldeployment(1), perforation(1). The

关键词： endoscopic necrosectomy Technical differences Walled-off necrosis Lumen-apposing metal stents International consensus Clinical outcomes

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Management of acute pancreatitis in Japan: analysis of nationwide epidemiological survey

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World Journal of Gastroenterology 2016年第28期22卷 6335-6344页

作者： Shin Hamada Atsushi Masamune Tooru Shimosegawa Division of Gastroenterology Tohoku University Graduate School of Medicine

Acute pancreatitis(AP) is an acute inflammatory disease of the exocrine pancreas. In Japan, nationwide epidemiological surveys have been conducted every 4 to 5 years by the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labour, and Welfare of Japan. We reviewed the results of the nationwide surveys focusing on the severity assessment and changes in the therapeutic strategy for walled-off necrosis. The severity assessment system currently used in Japan consists of 9 prognostic factors and the imaging grade on contrastenhanced computed tomography. By univariate analysis, all of the 9 prognostic factors were associated with AP-related death. A multivariate analysis identified 4 out of the 9 prognostic factors(base excess or shock, renal failure, systemic inflammatory response syndrome criteria, and age) that were associated with AP-related death. Receiver-operating characteristics curve analysis showed that the area under the curve was 0.82 for these 4 prognostic factors and 0.84 for the 9 prognostic factors, suggesting the comparable utility of these 4 factors in the severity assessment. We also examined the temporal changes in treatment strategy for walled-off necrosis in Japan according to the 2003, 2007, and 2011 surveys. Step-up approaches and lessinvasive endoscopic therapies were uncommon in 2003 and 2007, but became popular in 2011. Mortality has been decreasing in patients who require intervention for walled-off necrosis. In conclusion, the nationwide survey revealed the comparable utility of 4 prognostic factors in the severity assessment and the increased use of less-invasive, step-up approaches with improved clinical outcomes in the management of walled-off necrosis.

关键词： endoscopic necrosectomy Diagnostic criteria Epidemiology Pancreatic pseudocyst Systemic inflammatory response syndrome Step-up approach Walled-off necrosis

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Surgical management of necrotizing pancreatitis:An overview

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World Journal of Gastroenterology 2014年第43期20卷 16106-16112页

作者： George Kokosis Alexander Perez Theodore N Pappas Department of Surgery Duke University Medical CenterDurhamNC 27705United States

Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15%that reach 30%in case of *** open surgical debridement was the only tool in our disposal to manage this serious clinical *** approach is however associated with poor *** has now shifted away from open surgical debridement to a more conservative management and minimally invasive *** approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds:Delay,Drain and *** can be managed in the intensive care unit and any intervention should be *** drainage can be utilized first and early in the course of the disease,followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed *** surgery is now less frequently performed and should be reserved for cases refractory to any other *** management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.

关键词： Necrotizing pancreatitis Severe acute pancreatitis Debridement necrosectomy Infected necrosis endoscopic necrosectomy Video-assisted retroperitoneal debridement Percutaneous catheter drainage

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endoscopic ultrasound-guided pancreatic fluid collection drainage: Where are we?

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 273-281页

作者： Anupam Kumar Singh Manish Manrai Rakesh Kochhar Department of Gastroenterology Postgraduate Institute of Medical Education and ResearchChandigarh 160012India Department of Gastroenterology Command HospitalLucknow 226002India Department of Gastroenterology Paras HospitalPanchkula 134109India

Pancreatic fluid collections(PFCs)result from injury to the pancreas from acute or chronic pancreatitis,surgery,or *** of these collections has evolved over the last 2 *** choice of interventions includes percu-taneous,endoscopic,minimally invasive surgery,or a combined *** drainage is the drainage of PFCs by creating an artificial communication between the collection and gastrointestinal lumen that is maintained by placing a stent across the fistulous *** this editorial,we endeavored to update the current status of endoscopic ultrasound-guided drainage of PFCs.

关键词： Pancreatic fluid collections endoscopic ultrasound-guided drainage endoscopic necrosectomy Lumen apposing metal stent Review

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Quality of life after surgical and endoscopic management of severe acute pancreatitis: A systematic review

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World Journal of Gastrointestinal Endoscopy 2022年第7期14卷 443-454页

作者： Emmanouil Psaltis Chris Varghese Sanjay Pandanaboyana Manu Nayar Department of HPB and Transplant Surgery Newcastle upon Tyne NE77DNUnited Kingdom Department of Surgery Freeman HospitalNewcastle upon Tyne NE77DNUnited Kingdom Department of Surgery Faculty of Medical and Health SciencesUniversity of AucklandAuckland 1010New Zealand Population Health Sciences Institute Newcastle UniversityNewcastle upon Tyne NE17RUUnited Kingdom Department of Gastroenterology Freeman HospitalNewcastle upon Tyne NE77DNUnited Kingdom

BACKGROUND Treatment for severe acute severe pancreatitis(SAP)can significantly affect Health-related quality of life(HR-QoL).The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL in patients with SAP remain poorly *** To critically appraise the available evidence on HR-QoL following surgical or endoscopic necrosectomy in patient with *** A literature search was performed on PubMed,Google^(TM) Scholar,the Cochrane Library,MEDLINE and Reference Citation Analysis databases for studies that investigated HR-QoL following surgical or endoscopic necrosectomy in patients with *** collected included patient characteristics,outcomes of interventions and HR-QoL-related *** Eleven studies were found to have evaluated HR-QoL following treatment for severe acute pancreatitis including 756 *** studies were randomized trials,four were prospective cohort studies and four were retrospective cohort studies with prospective *** studies compared HR-QoL following surgical and endoscopic *** metrics of HR-QoL were used including Short Form(SF)-36 and *** randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical *** prospective study that examined HR-QoL following surgical necrosectomy reported some deterioration in the functional status of the *** the other hand,a cohort study that assessed the long-term HR-QoL following sequential surgical necrosectomy stated that all patients had SF-36>60%.In the only study that examined patients following endoscopic necrosectomy,the HR-QoL was also very *** studies investigated the quality adjusted life years suggesting that endoscopic and surgical approaches to management of pancreatic necrosis were comparable in cost ***,regarding HR-QoL between open necrose

关键词： Acute pancreatitis Pancreatic necrosis Surgical necrosectomy endoscopic necrosectomy Minimally invasive drainage Quality of life

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Lumen apposing metal stents for pancreatic fluid collections:Recognition and management of complications

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World Journal of Gastrointestinal Endoscopy 2017年第9期9卷 456-463页

作者： Michael L DeSimone Akwi W Asombang Tyler M Berzin Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical Schoo Center for Advanced Endoscopy Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical School

For patients recovering from acute pancreatitis,the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery,and introduces difficult management decisions with regard to when,whether,and how the collection should be *** PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary *** approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement),and the placement of percutaneous *** drainage techniques have emerged in the last several years as the preferred approach for most patients,when local expertise is ***-apposing metal stents(LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections,and less commonly,for other indications,such as gallbladder *** considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding,migration,buried stent,stent occlusion,and *** of the patient complexity associated with severe pancreatitis,management of pancreatic fluid collections can be a complex and multidisciplinary *** and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques,including how to recognize and manage expected complications.

关键词： Pancreatic fluid collection Lumen apposing metal stent endoscopic necrosectomy Cystgastrostomy

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