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. 2021 Jul;9(7):E1108-E1115.
doi: 10.1055/a-1480-7115. Epub 2021 Jun 21.

Management of walled-off necrosis with nasocystic irrigation with hydrogen peroxide versus biflanged metal stent: randomized controlled trial

Sudhir Maharshi  1 , Shyam Sunder Sharma  1 , Sandeep Ratra  1 , Bharat Sapra  1   2 , Dhruv Sharma  2
Affiliations

Management of walled-off necrosis with nasocystic irrigation with hydrogen peroxide versus biflanged metal stent: randomized controlled trial

Sudhir Maharshi et al. Endosc Int Open. 2021 Jul.

Abstract

Background and study aims Walled-off necrosis (WON) is a known complication of acute necrotizing pancreatitis (ANP). There is no study comparing nasocystic irrigation with hydrogen peroxide (H 2 O 2 ) versus biflanged metal stent (BMS) in the management of WON. The aim of this study was to compare the clinical efficacy of both the treatment strategies. Patients and methods This study was conducted on patients with symptomatic WON who were randomized to nasocystic irrigation with H 2 O 2 (Group A) and BMS placement (Group B). Primary outcomes were clinical and technical success while secondary outcomes were procedure time, adverse events, need for additional procedures, duration of hospitalization, and mortality. Results Fifty patients were randomized into two groups. Group A (n = 25, age 37.8 ± 17.6 years, 16 men) and Group B (n = 25, age 41.8 ± 15.2 years, 17 men). There were no significant differences in baseline characteristics between the two groups. The most common etiology of pancreatitis was alcohol, observed in 27 (54 %) patients. Technical success (100 % vs 96 %, P = 0.98), clinical success (84 % vs 76 %, P = 0.76), requirement of additional procedures (16 % vs 24 %, P = 0.70) and adverse events (4 vs 7, P = 0.06) were comparable in both the groups. The duration to clinical success (34.4 ± 12 vs 14.8 ± 10.8 days, P = 0.001) and procedure time (36 ± 15 vs 18 ± 12 minutes, P = 0.01) were longer in Group A compared to Group B. Conclusions Nasocystic irrigation with H 2 O 2 and BMS are equally effective in the management of WON but time to clinical success and procedure time is longer with nasocystic irrigation.

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Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of study design. WON, walled-off necrosis; EUS, endoscopic ultrasound; H 2 O 2, hydrogen peroxide; BMS, biflanged metal stent.
Fig. 2
Fig. 2
Endoscopic ultrasound (EUS)-guided drainage of walled-off necrosis (WON) using biflanged metal stent (BMS). a EUS image of WON. b Endoscopic image showing insertion of BMS in the WON cavity. c Successful deployment of BMS draining dirty fluid in gastric lumen. d Endoscopic view of WON cavity through BMS after 3 weeks showing collapsed cavity with healthy granulation tissue.
See this image and copyright information in PMC

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