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Review
. 2018 Sep;16(3):333-344.
doi: 10.1007/s11938-018-0189-8.

Endoscopic Management of Infected Necrotizing Pancreatitis: an Evidence-Based Approach

Lotte Boxhoorn  1 , Paul Fockens  1 , Marc G Besselink  2 , Marco J Bruno  3 , Jeanin E van Hooft  1 , Robert C Verdonk  4 , Rogier P Voermans  5 ; Dutch Pancreatitis Study Group
Affiliations
Review

Endoscopic Management of Infected Necrotizing Pancreatitis: an Evidence-Based Approach

Lotte Boxhoorn et al. Curr Treat Options Gastroenterol. 2018 Sep.

Abstract

Purpose of review: Endoscopic management of infected necrotizing pancreatitis has evolved rapidly over the past years and there have been interesting innovations in this field. This review provides an update on the most recently published literature regarding endoscopic management of infected necrotizing pancreatitis.

Recent findings: A recent randomized trial demonstrated no difference in mortality and major morbidity between endoscopic and surgical step-up treatment of infected necrotizing pancreatitis. However, endoscopic therapy resulted in shorter hospital stay and less pancreatic fistulas. Various innovations have been investigated with the aim to further optimize endoscopic therapy, in particular lumen-apposing metal stents. While major stent-related complications were also reported, findings from recent studies indicated that their use was associated with higher resolution rates of walled-off necrosis compared to double-pigtail stents. Other innovations, such as the multiple gateway technique and dual-modality mode, can be considered for treatment of particular cases. Furthermore, research suggests that irrigation of walled-off necrosis can be performed by using a nasocystic tube and discontinuation of proton-pump inhibitors may be considered. Endoscopic treatment should be the preferred treatment modality in patients with infected necrotizing pancreatitis who are eligible for endoscopic drainage. Although data suggests that lumen-apposing metal stents are superior to double-pigtail stents, prospective multicenter studies focusing on safety as well as long-term follow-up are first needed.

Keywords: Endoscopic drainage; Endoscopic necrosectomy; Infected necrotizing pancreatitis; Lumen-apposing metal stent; Walled-off necrosis.

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Conflict of interest statement

Conflict of Interest

Rogier Voermans reports grants as a consultant for Boston Scientific. Paul Fockens reports grants from Boston Scientific and personal fees from Cook, Ethicon Endosurgery, Fujifilm, Medtronic and Olympus, outside the submitted work. Marco Bruno reports grants industry and investigator initiated studies from Boston Scientific, Cook Medical, Pentax, and 3M; and personal fees from Boston Scientific, Cook Medical, Pentax, 3M outside the submitted work. Jeanin van Hooft reports grants from Cook Medical and Mylan and consultancy fees from Boston Scientific and Metronics, outside the submitted work. Robert Verdonk, Lotte Boxhoom, Marc Besselink declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Overview of the available lumen-apposing metal stents
See this image and copyright information in PMC

References

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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