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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2017

01-07-2017

The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study

Authors: Wen-Hua He, Yong Zhu, Yin Zhu, Pi Liu, Hao Zeng, Liang Xia, Chen Yu, Hai-Ming Chen, Xu Shu, Zhi-Jian Liu, You-Xiang Chen, Nong-Hua Lu

Published in: Surgical Endoscopy | Issue 7/2017

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Abstract

Background and study aim

The commonly used minimally invasive methods for patients with infected pancreatic necrosis (IPN) are initial endoscopic transluminal drainage (ETD) and percutaneous catheter drainage (PCD), which are followed, if necessary, by endoscopic or surgical necrosectomy. This study intends to explore which of the two minimally invasive treatments leads to a better prognosis.

Patients and methods

Patients with IPN and an indication for intervention were prospectively enrolled and underwent either initial ETD or PCD followed, if necessary, by endoscopic or surgical necrosectomy.

Results

Initial treatment success occurred in 8 of 11 patients after ETD (72.7%) and in 3 of 13 patients after PCD (30.8%) (risk ratio [RR] with ETD, 2.36; 95% CI 0.97–5.77; P = 0.04). After 1 year of follow-up, 72.7% of patients survived with ETD, and 69.2% survived with PCD (RR 1.05; 95% CI 0.63–1.75; P = 0.85). Intestinal fistula seems to have occurred less in the patients who received initial ETD rather than PCD therapy (9.1 vs. 38.5%; RR 0.24; 95% CI 0.03–1.73; P = 0.098). Fewer patients who underwent an initial ETD were transferred to surgery (9.1 vs. 46.2%; RR 0.20; 95% CI 0.03–1.40; P = 0.047). A higher rate of new-onset diabetes (3 cases) or impaired glucose tolerance (1 case) occurred in initial PCD compared to ETD (40 vs. 0%, P = 0.042).

Conclusion

The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis (ChiCTR-ONRC-13003653).
Literature
1.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS (2013) Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111CrossRefPubMed
2.
Banks PA, Freeman ML (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101(10):2379–2400CrossRefPubMed
3.
Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA (2010) Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 139(3):813–820CrossRefPubMed
4.
Raraty MG, Halloran CM, Dodd S, Ghaneh P, Connor S, Evans J, Sutton R, Neoptolemos JP (2010) Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. Ann Surg 251(5):787–793CrossRefPubMed
5.
Sleeman D, Levi DM, Cheung MC, Rahnemai-Azar A, Parisek S, Casillas V, Echenique A, Yrizarri J, Guerra JJ, Levi JU et al (2011) Percutaneous lavage as primary treatment for infected pancreatic necrosis. J Am Coll Surg 212(4):748–752; discussion 752–744
6.
Tong Z, Li W, Yu W, Geng Y, Ke L, Nie Y, Sun J, Ni H, Wang X, Ye X et al (2012) Percutaneous catheter drainage for infective pancreatic necrosis: is it always the first choice for all patients? Pancreas 41(2):302–305CrossRefPubMed
7.
Wronski M, Cebulski W, Karkocha D, Slodkowski M, Wysocki L, Jankowski M, Krasnodebski IW (2013) Ultrasound-guided percutaneous drainage of infected pancreatic necrosis. Surg Endosc 27(8):2841–2848CrossRefPubMedPubMedCentral
8.
van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG, Gooszen HG (2011) Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 98(1):18–27CrossRefPubMed
9.
Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, van Eijck CH, Fockens P, Hazebroek EJ, Nijmeijer RM et al (2012) Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA, J Am Med Assoc 307(10):1053–1061CrossRef
10.
Tenner S, Baillie J, Dewitt J, Vege SS (2013) American College of Gastroenterology Guidelines: management of Acute Pancreatitis. Am J Gastroenterol 108(9):1400–1415CrossRefPubMed
11.
Schrover IM, Weusten BL, Besselink MG, Bollen TL, van Ramshorst B, Timmer R (2008) EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis. Pancreatology 8(3):271–276CrossRefPubMed
12.
Voermans RP, Veldkamp MC, Rauws EA, Bruno MJ, Fockens P (2007) Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc 66(5):909–916CrossRefPubMed
13.
van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL et al (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362(16):1491–1502CrossRefPubMed
14.
Beger HG, Buchler M, Bittner R, Oettinger W, Block S, Nevalainen T (1988) Necrosectomy and postoperative local lavage in patients with necrotizing pancreatitis: results of a prospective clinical trial. World J Surg 12(2):255–262CrossRefPubMed
15.
Seifert H, Biermer M, Schmitt W, Jurgensen C, Will U, Gerlach R, Kreitmair C, Meining A, Wehrmann T, Rosch T (2009) Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 58(9):1260–1266CrossRefPubMed
16.
Guidelines WGIAAP (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13(4 Suppl 2):e1–e15
17.
Kumar N, Conwell DL, Thompson CC (2014) Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization. Pancreas 43(8):1334–1339CrossRefPubMedPubMedCentral
18.
Siddiqui AA, Adler DG, Nieto J, Shah JN, Binmoeller KF, Kane S, Yan L, Laique SN, Kowalski T, Loren DE et al (2016) EUS-guided drainage of peripancreatic fluid collections and necrosis using a novel lumen-apposing stent: a large retrospective multicenter U.S. experience (with videos). Gastrointest Endosc 83(4):699–707CrossRefPubMed
19.
Chandran S, Efthymiou M, Kaffes A, Chen JW, Kwan V, Murray M, Williams D, Nguyen NQ, Tam W, Welch C et al (2015) Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos). Gastrointest Endosc 81(1):127–135CrossRefPubMed
20.
van Brunschot S, Fockens P, Bakker OJ, Besselink MG, Voermans RP, Poley JW, Gooszen HG, Bruno M, van Santvoort HC (2014) Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. Surg Endosc 28(5):1425–1438CrossRefPubMed
21.
Carter CR, McKay CJ, Imrie CW (2000) Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg 232(2):175–180CrossRefPubMedPubMedCentral
22.
Mui LM, Wong SK, Ng EK, Chan AC, Chung SC (2005) Combined sinus tract endoscopy and endoscopic retrograde cholangiopancreatography in management of pancreatic necrosis and abscess. Surg Endosc 19(3):393–397CrossRefPubMed
23.
Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, Bulger E, Sinanan M, Langdale L, Kolokythas O et al (2010) Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg 145(9):817–825CrossRefPubMed
24.
van Brunschot S, van Grinsven J, Voermans RP, Bakker OJ, Besselink MG, Boermeester MA, Bollen TL, Bosscha K, Bouwense SA, Bruno MJ et al (2013) Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711]. BMC Gastroenterol 13:161CrossRefPubMedPubMedCentral
Metadata
Title
The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study
Authors
Wen-Hua He
Yong Zhu
Yin Zhu
Pi Liu
Hao Zeng
Liang Xia
Chen Yu
Hai-Ming Chen
Xu Shu
Zhi-Jian Liu
You-Xiang Chen
Nong-Hua Lu
Publication date
01-07-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5324-9

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