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Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

World Journal of Gastroenterology 2020年第41期26卷 6431-6441页

作者： Fang Liu Liang Wu Xiang-Dong Wang Jian-Guo Xiao Wen Li Department of Gastroenterology and Hepatology Medical School of Chinese PLABeijing 100853China Department of Gastroenterology and Hepatology The First Medical CenterChinese PLA General HospitalBeijing 100853China Department of International Center for Diagnosis and Treatment of Liver Disease The Fifth Medical CenterChinese PLA General HospitalBeijing 100039China Department of Critical Care Medicine The First Medical CenterChinese PLA General HospitalBeijing 100853China

BACKGROUND Endoscopic drainage of walled-off necrosis(WON) is still a challenge due to stentassociated problems. We explored endoscopic gastric fenestration(EGF) as an innovative alternative *** To assess the feasibility, efficacy and safety of EGF for *** Between March 2019 and March 2020, five patients with symptomatic WON in close contact with the stomach wall were treated by EGF. Endoscopic ultrasound(EUS) was used to select appropriate sites for gastric fenestration, which then proceeded layer by layer as in endoscopic submucosal dissection. Both the stomach muscularis propria and pseudocyst capsule were penetrated. Fenestrations were expanded up to 1.5-3 cm for drainage or subsequent *** EGF failed in Case 1 due to nonadherence of WON to the gastric wall. EGF was successfully implemented in the other four cases by further refinement of fenestration site selection according to computed tomography, endoscopy and EUS features. The average procedure time for EGF was 124 min(EUS assessment, 32.3 min;initial fenestration, 28.8 min;expanded fenestration, 33 min), and tended to decrease as experience gradually increased. The diameter of the fenestration site was 1.5-3 cm, beyond the caliber of a lumen-apposing metal stent(LAMS), to ensure effective drainage or subsequent necrosectomy. Fenestration sites showed surprising capacity for postoperative self-healing within 1-3 wk. No EGF-related complications were seen. WON disappeared within 3 wk after EGF. In Case 3, another separate WON, treated by endoscopic LAMS drainage, recurred within 4 d after LAMS removal due to stent-related hemorrhage, and resolved slowly over almost 3 mo. No recurrences were observed in the five *** EGF is an innovative and promising alternative intervention for WON adherent to the gastric wall. The challenge resides in the gauging of actual adherence and in selecting appropriate fenestration sites.

关键词： Endoscopic gastric fenestration walled-off necrosis Lumen-apposing metal stents Stent-related complications

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Multiple hidden vessels in walled-off necrosis with high-risk bleeding: Report of two cases

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World Journal of Clinical Cases 2021年第27期9卷 8214-8219页

作者： Ning Xu Ya-Qi Zhai Long-Song Li Ning-Li Chai Department of Gastroenterology and Hepatology Chinese PLA General HospitalBeijing 100853China

BACKGROUND walled-off necrosis(WON),as a local complication of acute necrotizing pancreatitis,is difficult to differentiate from pancreatic pseudocysts(PPC).Imaging modalities such as computed tomography show a lower accuracy than endoscopic ultrasound(EUS)in confirming the ***-guided cystogastrostomy following direct endoscopic necrosectomy has achieved excellent results and has been regarded as a preferred alternative to traditional ***,highrisk bleeding is one of the greatest *** SUMMARY Two patients with symptomatic pancreatic fluid collections(PFCs)were admitted to our hospital for EUS-guided lumen-apposing metal stent *** female patient suffered from intermittent abdominal pain and underwent two perioperative CT *** male patient had recurrent pancreatitis and showed a growing *** initial diagnosis was a PPC according to contrast-enhanced ***,the evidence of solid contents on EUS prompted revision of the diagnosis to *** endoscope was inserted into the cavity,and some necrotic debris and multiple hidden vascular structures were *** to conservative treatment by irrigation with sterile water instead of direct necrosectomy,we successfully avoided damaging hidden vessels and reduced the risk of intraoperative *** The application of EUS is helpful for the identification of *** intervention should be conducted for WON with multiple vessels to prevent bleeding.

关键词： walled-off necrosis Computed tomography Endoscopic ultrasound Vessel bleeding Case report

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Short-and long-term results of endoscopic ultrasoundguided transmural drainage for pancreatic pseudocysts and walled-off necrosis

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World Journal of Gastroenterology 2017年第39期23卷 7110-7118页

作者： Yuto Watanabe Rintaro Mikata Shin Yasui Hiroshi Ohyama Harutoshi Sugiyama Yuji Sakai Toshio Tsuyuguchi Naoya Kato Department of Gastroenterology Graduate School of Medicine Chiba University

AIM To evaluate the short-and long-term results of endoscopic ultrasound-guided transmural drainage(EUS-GTD) for pancreatic fluid collection(PFC) and identify the predictive factors of treatment outcome for walled-off necrosis(WON) managed by EUS-GTD *** We investigated 103 consecutive patients with PFC who underwent EUS-GTD between September 1999 and August 2015. Patients were divided into four groups as follows: WON(n = 40), pancreatic pseudocyst(PPC; n = 11), chronic pseudocyst(n = 33), and others(n = 19). We evaluated the short-and long-term outcomes of the treatment. In cases of WON, multiple logistic regression analyses were performed to identify the predictor variables associated with the treatment success. In addition, PFC recurrence was examined in patients followed up for more than 6 mo and internal stent removal after successful EUS-GTD was *** In this study, the total technical success rate was 96.1%. The treatment success rate of WON, PPC, chronic pseudocyst, and others was 57.5%, 90.9%, 91.0%, and 89.5%, respectively. Contrast-enhanced computed tomography using the multivariate logistic regression analysis revealed that the treatment success rate of WON was significantly lower in patients with more than 50% pancreatic parenchymal necrosis(OR = 17.0; 95%CI: 1.9-150.7; P = 0.011) and in patients with more than 150 mm of PFC(OR = 27.9; 95%CI: 3.4-227.7; P = 0.002).The recurrence of PFC in the long term was 13.3%(median observation time, 38.8 mo). Mean amylase level in the cavity was significantly higher in the recurrence group than in the no recurrence group(P = 0.02).CONCLUSION The reduction of WON by EUS-GTD alone was associated with the proportion of necrotic tissue and extent of the cavity. The amylase level in the cavity may be a predictive factor for recurrence of PFC.

关键词： Endoscopic ultrasound-guided transmural drainage Pancreatic fluid collection Revised Atlanta Classification walled-off necrosis

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Endoscopic ultrasonography-guided endoscopic treatment of pancreatic pseudocysts and walled-off necrosis:New technical developments

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World Journal of Gastroenterology 2014年第43期20卷 16191-16196页

作者： Barbara Braden Christoph F Dietrich Translational Gastroenterology Unit Oxford University Hospitals NHS TrustOxford OX3 9DUUnited Kingdom Med.Klinik 2 Caritas HospitalUhlandstr.797980 Bad MergentheimGermany

In the last decades,the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic *** procedures can be avoided in many cases by using endoscopically placed,Endoscopic ultrasonography-guided techniques and *** ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid *** development of selfexpanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid *** review will discuss available therapeutic techniques and new developments.

关键词： Pancreatic pseudocyst walled-off necrosis Endoscopic ultrasonography-guided drainage Self-expanding metal stent Acute pancreatitis

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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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世界临床病例杂志 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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Comparative outcomes of endoscopic ultrasound-guided lumen-apposing mental stents drainage for pancreatic pseudocysts and walled-off necrosis:Case series and meta-analysis

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Chronic Diseases and Translational Medicine 2021年第3期7卷 157-168页

作者： Jing Li Qian Zhang Anni Zhou Guiping Zhao Peng Li Department of Gastroenterology Beijing Friendship HospitalCapital Medical UniversityNational Clinical Research Center for Digestive DiseasesBeijing Digestive Disease CenterBeijing Key Laboratory for Precancerous Lesion of Digestive DiseasesBeijing 100050China

Background:Endoscopic ultrasound(EUS)-guided transmural drainage for pancreatic fluid collections(PFCs)has become the first-line treatment with quicker recovery and more minor injury compared with surgery and percutaneous *** efficacy of stents implantation and drainage for different PFCs remains controversial,especially lumen-apposing metal stents(LAMS).This study aimed to compare the efficacy and safety of LAMS drainage for pancreatic pseudocysts(PPC)and walled-off necrosis(WON).Methods:A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed,Cochrane,and Embase databases from January 2010 to January *** 2017 to 2019,12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this ***:Combining 11 copies of documents with the data from our medical center,a total of 585 patients with PFCs were enrolled in this meta-analysis,including 343 patients with WON and 242 with *** technical success rate in WON is not significantly different from that of PPC(P=0.08>0.05).The clinical success of LAMS placement was achieved in 99%vs 89%in PPC and WON,respectively(RR=0.92,95%CI:0.86-0.98,P=0.01<0.05).The further intervention of direct endoscopic necrosectomy was required by 60%of patients in WON *** was no significant difference in the incidence of adverse events,including infection,bleeding,stent migration and stent occlusion,after LAMS placement between WON and ***:Endoscopic ultrasound-guided LAMS for PFCs are feasible,effective with preferable technical and clinical success *** clinical effect of LAMS on PPC is slightly better than that of WON,but its adverse reactions still need to be verified in a large-sample prospective study.

关键词： Pancreatic pseudocyst walled-off necrosis Endoscopic treatment Lumen-apposing metal stents

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Modified single transluminal gateway transcystic multiple drainage technique for a huge infected walled-off pancreatic necrosis: A case report

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World Journal of Gastroenterology 2016年第21期22卷 5132-5136页

作者： Kosuke Minaga Masayuki Kitano Hajime Imai Kentaro Yamao Ken Kamata Takeshi Miyata Tomohiko Matsuda Shunsuke Omoto Kumpei Kadosaka Tomoe Yoshikawa Masatoshi Kudo Department of Gastroenterology and Hepatology Kinki University Faculty of Medicine

We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) technique. After placing a widecaliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.

关键词： Endoscopic ultrasonography Infected pancreatic necrosis walled-off necrosis Endoscopic ultrasonography-guided drainage Acute pancreatitis

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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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Imaging lexicon for acute pancreatitis:2012 Atlanta Classification revisited

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Gastroenterology Report 2016年第1期4卷 16-23,I0001页

作者： Binit Sureka Kalpana Bansal Yashwant Patidar Ankur Arora Department of Radiology/Interventional Radiology Institute of Liver and Biliary SciencesNew DelhiIndia

The original 1992 Atlanta Classification Systemfor acute pancreatitis was revised in 2012 by the Atlanta Working Group,assisted by various national and international societies,through web-based *** revised classification identifies two phases of acute pancreatitis:early and *** pancreatitis can be either oedematous interstitial pancreatitis or necrotizing *** of the disease is categorized into three levels:mild,moderately severe and severe,depending upon organ failure and local/systemic *** to the type of pancreatitis,collections are further divided into acute peripancreatic fluid collection,pseudocyst,acute necrotic collection,and walled-off *** into the revised terminology is essential for accurate communication of imaging *** this review article,we will summarize the updated nomenclature and illustrate corresponding imaging findings using examples.

关键词： acute pancreatitis imaging acute peripancreatic fluid collection pseudocyst walled-off necrosis

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Invasive intervention timing for infected necrotizing pancreatitis: Late invasive intervention is not late for collection

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World Journal of Clinical Cases 2022年第23期10卷 8057-8062页

作者： Nian-Jun Xiao Ting-Ting Cui Fang Liu Wen Li Department of Gastroenterology Air Force Medical CenterAir Force Medical UniversityBeijing 100142China Department of Gastroenterology and Hepatology Medical School of Chinese PLABeijing 100853China Department of Gastroenterology and Hepatology The First Medical CenterChinese PLA General HospitalBeijing 100853China

With the advance of invasive interventions,the treatment model for infected necrotizing pancreatitis(INP)has shifted from open surgery to the step-up minimally invasive *** intervention,originating from the open surgery era,has been questioned in the minimally invasive *** the emergence of new high-quality evidence about the timing for intervention,it seems to be increasingly apparent that,even in the age of minimal invasiveness,“late intervention”waiting for the necrotic collections to be encapsulated is still *** opinion review mainly discusses the intervention timing for INP.

关键词： Pancreatitis walled-off necrosis Minimally invasive surgery Endoscopic drainage Endoscopic gastric fenestration

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