Double-catheter lavage combined with percutaneous flexible endoscopic debridement for infected pancreatic necrosis failed to percutaneous catheter drainage

Abstract

Background: Infected pancreatic necrosis (IPN) is a serious local complication of acute pancreatitis, with high mortality. Minimally invasive therapy including percutaneous catheter drainage (PCD) has become the preferred method for IPN instead of traditional open necrosectomy. However, the efficacy of double-catheter lavage in combination with percutaneous flexible endoscopic debridement after PCD failure is unknown compared with surgical necrosectomy.

Methods: A total of 27 cases of IPN patients with failure PCD between Jan 2014 and Dec 2015 were enrolled in this retrospective cohort study. Fifteen patients received double-catheter lavage in combination with percutaneous flexible endoscopic debridement, and 12 patients underwent open necrosectomy. The primary endpoint was the composite end point of major complications or death. The secondary endpoint included mortality, major complication rate, ICU admission length of stay, and overall length of stay.

Results: The primary endpoint occurrence rate in double-catheter lavage in combination with percutaneous flexible endoscopic debridement group (8/15, 53%) was significantly lower than that in open necrosectomy group (11/12, 92%) (RR = 1.71, 95% CI = 1.04 - 2.84, P < 0.05). Though the mortality between two groups showed no statistical significance (0% vs. 17%, P = 0.19), the rate of new-onset multiple organ failure and ICU admission length of stay in the experimental group was significantly lower than that in open necrosectomy group (13% vs. 58%, P = 0.04; 0 vs. 17, P = 0.02, respectively). Only 40% of patients required ICU admission after percutaneous debridement, which was markedly lower than the patients who underwent surgery (83%; P < 0.05).

Conclusions: Double-catheter lavage in combination with percutaneous flexible endoscopic debridement showed superior effectiveness, safety, and convenience in patients with IPN after PCD failure as compared to open necrosectomy.

Keywords: Double-catheter lavage; Infected pancreatic necrosis; Open necrosectomy; Percutaneous catheter drainage; Percutaneous flexible endoscopic debridement.

Fig. 1

Flow chart

Fig. 2

Double-catheter lavage in combination with gastroscopic debridement treatment: a A percutaneous 8 to14 French pigtail catheter is placed in the peripancreatic collection under guidance of CT or ultrasound; b-c A double catheter is placed for continuous irrigation and drainage after the sinus tract was expanded using 14–30Fr dilators; d Gastroscopic debridement: the necrosis is removed under direct vision with a long grasping forceps; e The double catheter is placed back for continuous irrigation and drainage. The images are designed and drawn by ourselves

Fig. 3

Double-catheter lavage in combination with gastroscopic debridement. a before percutaneous debridement. b PCD drainage tube placement. c double catheter placement. d after percutaneous debridement. e recovery phase. f before debridement. g after debridement. h and i, necrotic tissue