Review
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Endoscopic Transmural Necrosectomy: Timing, Indications, and Methods
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Rungsun Rerknimitr
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Clin Endosc 2020;53(1):49-53. Published online September 18, 2019
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DOI: https://doi.org/10.5946/ce.2019.131
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Abstract
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- Walled-off necrosis is considered one of the most severe complications after an episode of severe acute pancreatitis. Traditionally, percutaneous drainage is selected as the first treatment step, while open surgery can be planned as a secondary option if necrosectomy is required. In recent years, endoscopic necrosectomy has evolved as a more favorable approach. To date, a step-up treatment strategy is recommended, particularly when a plastic stent is selected as the drainage device. Multi-gateway endoscopic therapy may be used in a step-up fashion if only one stent fails to clear debris. Over many years, there has been an evolution in stent selection, from plastic to metallic stents. Within a few years of its clinical usage, lumen-apposing stents are gaining more popularity as they offer direct endoscopic necrosectomy and only require a few sessions.
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Citations
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Special Issue Articleses of IDEN 2012
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Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis
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Michel Kahaleh
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Clin Endosc 2012;45(3):313-315. Published online August 22, 2012
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DOI: https://doi.org/10.5946/ce.2012.45.3.313
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Abstract
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Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis with significant mortality. Surgical debridement is the traditional management of necrotizing pancreatitis, but it is associated with significant morbidity and mortality. Endoscopic necrosectomy using repeats session of debridement and stent insertion has been more frequently used within the last decade and half. This technique continues to evolve as we attempt to optimize the post-procedural outcomes.
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Citations
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- Wernicke Encephalopathy after Endoscopic Necrosectomy in Acute Necrotizing Pancreatitis with WOPN: A Case Report
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