Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Nov;28(11):1725-32.
doi: 10.1111/jgh.12328.

Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis

Ji Young Bang  1 , C Mel Wilcox, Jessica Trevino, Jayapal Ramesh, Shajan Peter, Muhammad Hasan, Robert H Hawes, Shyam Varadarajulu
Affiliations

Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis

Ji Young Bang et al. J Gastroenterol Hepatol. 2013 Nov.

Abstract

Background: Treatment outcomes are suboptimal for patients undergoing endoscopic treatment of walled-off pancreatic necrosis (WOPN). The objective of this study is to identify factors that impact treatment outcomes in this patient subset.

Methods: This is a retrospective study of patients with WOPN treated endoscopically over 10 years. Patients underwent placement of stents and nasocystic catheters within the necrotic cavity. In select patients, the multiple transluminal gateway technique (MTGT) was adopted to create several openings in the stomach or duodenum to facilitate drainage of necrosis. In patients with disconnected pancreatic duct syndrome (DPDS), the transmural stents were left in place indefinitely to decrease pancreatic fluid collection (PFC) recurrence.

Results: Endoscopic treatment was successful in 53 of 76 (69.7%) patients. Treatment success was higher in patients undergoing MTGT than in those in whom conventional drainage was used (94.4% vs. 62.1%, P = 0.009). On multivariate logistic regression analysis, only MTGT (OR 15.8, 95% CI 1.77-140.8; P = 0.01) and fewer endoscopic sessions being needed (OR 4.0, 95% CI 1.16-14.0; P = 0.03) predicted treatment success. PFC recurrence was significantly lower in patients with indwelling transmural stents than in patients in whom the stents were removed (0 vs. 20.8%; P = 0.02).

Conclusions: Creating multiple gateways for drainage of necrotic debris improves treatment success, and not removing the transmural stents decreases PFC recurrence in patients undergoing endoscopic drainage of WOPN.

Keywords: EUS-guided drainage; disconnected pancreatic duct syndrome; endoscopic management; outcomes; walled-off pancreatic necrosis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Illustration demonstrating the standard technique for endoscopic drainage of a walled-off pancreatic necrosis.
Figure 2
Figure 2
Illustration demonstrating the multiple transluminal gateway technique for endoscopic drainage of a walled-off pancreatic necrosis.
Figure 3
Figure 3
(a) Computed tomography of the abdomen (axial image) showing a large walled-off pancreatic necrosis (> 20 cm) containing a large amount of necrotic debris. (b) Computed tomography of the abdomen (coronal image) showing marked resolution of the walled-off pancreatic necrosis in the same patient following drainage using the multiple transluminal gateway technique.
Figure 4
Figure 4
(a) Pancreatogram of a patient with a walled-off pancreatic necrosis in whom double pigtail stents were placed. (b) Magnetic retrograde cholangiopancreatography of a patient following removal of the transmural stent showing opacification of the disconnected pancreatic duct and associated peripancreatic fluid collection.
See this image and copyright information in PMC

References

    1. Takahashi N, Papachristou GI, Schmit GD. CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur. Radiol. 2008;18:2522–2529. - PubMed
    1. Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology Practice guidelines in acute pancreatitis. Am. J. Gastroenterol. 2006;101:2379–2400. - PubMed
    1. Nathens JB, Curtis JR, Beale RJ, et al. Management of the critically ill patient with severe acute pancreatitis. Crit. Care Med. 2004;32:2524–2536. - PubMed
    1. AGA Institute Governing Board. AGA Institute medical position statement on acute pancreatitis. Gastroenterology. 2007;131:2019–2021. - PubMed
    1. Brunschot SV, Bakker OJ, Besselink MG, et al. Dutch Pancreatitis Study Group. Treatment of necrotizing pancreatitis. Clin. Gastroenterol. Hepatol. 2012;10:1190–1201. - PubMed

MeSH terms