Clin Endosc.  2018 May;51(3):279-284. 10.5946/ce.2017.066.

Pancreatic Necrosectomy through Sinus Tract Endoscopy

• Goenka MK
• Goenka U
• Mujoo M
• Tiwary IK
• Mahawar S
• Rai VK

• KMID: 2414870
• DOI: http://doi.org/10.5946/ce.2017.066

Abstract

BACKGROUND/AIMS
Direct endoscopic pancreatic necrosectomy is increasingly being utilized to treat infected or symptomatic walled-off necrosis (WON) located close to the stomach or duodenum. Laterally-placed WON has traditionally been treated surgically. We evaluated a less utilized technique of sinus tract endoscopy (STE) for symptomatic laterally-placed WON.
METHODS
Two hundred seventy-six patients with acute pancreatitis admitted in our hospital, 32 had symptomatic or infected WON requiring intervention. Of the 12 patients with laterally placed WON, 10 were treated by STE. STE was performed with a standard adult gastroscope passed through a percutaneous tract created by the placement of a 32-Fr drain.
RESULTS
Ten patients (7 males; mean age, 43.8 years) underwent STE. Mean number of sessions was 2.3 (range, 1-4), with mean time of 70 minutes for each session (range, 15-70 minutes). While 9 patients had complete success, 1 patient had fever and chose to undergo surgery. Two patients developed pneumoperitoneum, which was treated conservatively. There was no mortality, cutaneous fistula, or recurrence during follow-up.
CONCLUSIONS
Laterally placed WON can be successfully managed by STE performed through a percutaneously placed drain. Details of the technique and end-points of STE require further evaluation.

Keyword

Walled-off necrosis; Pancreatitis, acute necrotizing; Sinus tract endoscopy; Necrosectomy

MeSH Terms

Adult
Cutaneous Fistula
Duodenum
Endoscopy*
Fever
Follow-Up Studies
Gastroscopes
Humans
Male
Mortality
Necrosis
Pancreatitis
Pancreatitis, Acute Necrotizing
Pneumoperitoneum
Recurrence
Stomach

Figure

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  Fig. 1. Outcome of patients admitted with acute pancreatitis. WON, walled-off necrosis.

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  Fig. 2. Sinus track endoscopy (STE). (A) Computed tomography (CT) scan showing a walled-off necrosis (WON) with a 32 Fr percutaneous catheter (arrows) placed in it. (B) Percutaneous catheter being removed to perform STE. (C) Necrotic material inside the WON. (D) Necroscectomy being performed. (E) End point of necrosectomy showing healthy granulation tissue. (F) Necrotic tissue after removal. (G) CT scan showing near resolution of WON. Also note a self-expanding stent (arrows) placed through the stomach to drain peri-gastric WON.

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