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Lu B, Yin JJ, Wang JR, Xu X, Cai Y. Combination of ultrasonic lithotripsy system and video-assisted retroperitoneal debridement in treatment of laterally located pancreatic walled-off necrosis. Hepatobiliary Pancreat Dis Int 2024:S1499-3872(24)00073-0. [PMID: 38839504 DOI: 10.1016/j.hbpd.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Bei Lu
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Jun-Jie Yin
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Jing-Rui Wang
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Xiao Xu
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Yang Cai
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China.
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Ebrahim M, Werge MP, Novovic S, Amin NEL, Karstensen JG, Jørgensen HL. Prediction of Admission to Intensive Care Unit and 1-Year Mortality After Acute Pancreatitis With Walled-Off Pancreatic Necrosis: A Retrospective, Single-Center Cohort Study. Pancreas 2024; 53:e386-e394. [PMID: 38416852 DOI: 10.1097/mpa.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND AIMS Pancreatic walled-off necrosis (WON) carries significant mortality and morbidity risks, often necessitating intensive care unit (ICU) admission. This retrospective study aimed to evaluate whether routine biochemical parameters at the time of the index endoscopic procedure could predict ICU admission and 1-year mortality following endoscopic treatment of WON. MATERIALS AND METHODS We retrospectively identified 201 consecutive patients who underwent endoscopic drainage for WON between January 1, 2010, and December 31, 2020. Associations between routine biochemical blood tests and outcomes were assessed using logistic regression models. RESULTS Within 1 year of the index endoscopy, 31 patients (15.4%) died, and 40 (19.9%) were admitted to the ICU due to sepsis. Preoperative electrolyte disturbances were more prevalent among ICU-admitted patients and nonsurvivors. Hyperkalemia, hypoalbuminemia, and elevated urea were significant predictors of 1-year mortality, while hypernatremia, elevated serum creatinine, and hypoalbuminemia predicted ICU admission. Predictive models exhibited good discriminative ability, with an AUC of 0.84 (95% CI,0,75-0.93) for 1-year mortality and 0.86 (95%CI, 0.79-0.92) for ICU admission. CONCLUSIONS Preoperative imbalances in routine blood tests effectively predict adverse outcomes in endoscopically treated WON patients.
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Affiliation(s)
- Mohamed Ebrahim
- From the Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Mikkel Parsberg Werge
- From the Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Nadia Emad Lotfi Amin
- From the Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
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Ebrahim M, Novovic S, Schmidt PN, Feldager Hansen E, Karstensen JG. EUS-guided transcolonic drainage and necrosectomy in walled-off necrosis: a retrospective, single-center case series. Endosc Int Open 2023; 11:E618-E622. [PMID: 37854888 PMCID: PMC10581201 DOI: 10.1055/a-2095-0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background and study aims Transgastric endoscopic ultrasound (EUS)-guided drainage and, if needed, necrosectomy is the preferred treatment in patients with pancreatic walled-off necrosis. EUS-guided transcolonic or transrectal drainage and necrosectomy may serve as a minimally invasive alternative in cases in which transgastric or percutaneous drainage is either impossible or fails to secure sufficient drainage. In this paper, we retrospectively evaluated the feasibility, safety, and efficacy of the treatment. We included nine patients and found a technical success rate of 100%, clinical success in 89%, and one adverse event (11%). Transrectal/transcolonic endoscopic necrosectomy was needed in seven patients (78%).
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Affiliation(s)
- Mohamed Ebrahim
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark
| | - Srdan Novovic
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Palle Nordblad Schmidt
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark
| | - Erik Feldager Hansen
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark
| | - John Gásdal Karstensen
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
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Zhang B, Gao T, Wang Y, Zhu H, Liu S, Chen M, Yu W, Zhu Z. A novel mini-invasive step-up approach for the treatment of severe acute pancreatitis with extensive infected necrosis: A single center case series study. Medicine (Baltimore) 2023; 102:e33288. [PMID: 36930105 PMCID: PMC10019169 DOI: 10.1097/md.0000000000033288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
RATIONALE Complete removal of necrosis is critical for treating patients with severe acute pancreatitis (SAP) presenting infection of pancreatic necrosis (IPN). Frequently used mini-invasive methods include the surgical step-up approach suitable for necrosis extending laterally, whereas the endoscopic step-up approach is suitable for medial necrosis. However, in patients with extensive IPN, either approach alone usually has limited treatment effects. PATIENT CONCERNS We describe a case series of combined mini-invasive step-up approach for treating extensive IPN. DIAGNOSES Patients were diagnosed with SAP and had extensive IPN. INTERVENTIONS Seven patients with SAP and extensive IPN were enrolled. All patients underwent a combined step-up approach comprising 4 steps: percutaneous catheter drainage, continuous negative pressure irrigation (CNPI), percutaneous endoscopic necrosectomy (PEN), and transgastric necrosectomy (TN). OUTCOMES The median interval from symptom onset to percutaneous catheter drainage and CNPI was 11 days (range, 6-14) and 18 days (range, 14-26), and the median CNPI duration was 84 days (range, 54-116). The median interval from the onset of symptoms to PEN and TN was 36 days (range, 23-42) and 41 days (range, 34-48), respectively, and the median number of procedures was 2 (range, 1-2) for PEN and 3 (range, 2-4) for TN. Only a minor case of abdominal bleeding and a pancreatic-cutaneous fistula were reported, both resolved after conservative treatment. The median length of stay in the intensive care unit was 111 days (range, 73-133); all patients survived. LESSONS This mini-invasive step-up approach shows promising clinical effects and is relatively safe in critically ill patients with extensive IPN and high-risk surgical intervention.
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Affiliation(s)
- Beiyuan Zhang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Tao Gao
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Yan Wang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Hao Zhu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Ming Chen
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Zhanghua Zhu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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Karstensen JG, Novovic S, Hansen EF, Jensen AB, Jorgensen HL, Lauritsen ML, Werge MP, Schmidt PN. EUS-guided drainage of large walled-off pancreatic necroses using plastic versus lumen-apposing metal stents: a single-centre randomised controlled trial. Gut 2022; 72:1167-1173. [PMID: 36446550 DOI: 10.1136/gutjnl-2022-328225] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE In treating pancreatic walled-off necrosis (WON), lumen-apposing metal stents (LAMS) have not proven superior to the traditional double pigtail technique (DPT). Among patients with large WON (>15 cm) and their associated substantial risk of treatment failure, the increased drainage capacity of a novel 20-mm LAMS might improve clinical outcomes. Hence, we conducted a study comparing the DPT and 20-mm LAMS in patients with large WON. DESIGN A single-centre, open-label, randomised, controlled superiority trial using an endoscopic step-up approach in patients with WON exceeding 15 cm in size. The primary endpoint was the number of necrosectomies needed to achieve clinical success (clinical and CT resolution), while the secondary endpoints included technical success, adverse events, length of stay and mortality. RESULTS Twenty-two patients were included in the DPT group and 20 in the LAMS group, with no significant differences in patient characteristics. The median size of WON was 24.1 cm (P25-P75: 19.6-31.1). The technical success rates were 100% for DPT and 95% for LAMS (p=0.48), while clinical success rates were 95.5% and 94.7%, respectively (p=1.0). The mean number of necrosectomies was 2.2 for DPT and 3.2 for LAMS (p=0.42). Five patients (12%) developed procedure-related serious adverse events (DPT=4, LAMS=1, p=0.35). The median length of stay was 43 (P25-P75: 40-67) and 58 days (P25-P75: 40-86) in the DPT and LAMS groups (p=0.71), respectively, with an overall mortality of 4.8%. CONCLUSIONS For treating large WON, LAMS are not superior to DPT. The techniques are associated with comparable needs for necrosectomy and hospital stay, and no gross difference in adverse events. TRIAL REGISTRATION NUMBER NCT04057846.
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Affiliation(s)
- John Gásdal Karstensen
- Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Srdan Novovic
- Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Erik Feldager Hansen
- Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Annette Bojer Jensen
- Department of Radiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Henrik Lovendahl Jorgensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Laksafoss Lauritsen
- Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Parsberg Werge
- Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Palle Nordblad Schmidt
- Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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Pérez-Cuadrado Robles E, Ragot E, Alric H, Di Gaeta A, Benosman H, Cellier C, Rahmi G. Hybrid retroperitoneal necrosectomy using a triple-port approach under endoscopic guidance. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:694. [PMID: 35815789 DOI: 10.17235/reed.2022.9055/2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Complex walled-off necrosis with a retroperitoneal component represent a therapeutic challenge. Although mini-invasive approaches have been described, hybrid procedures combining surgical, endoscopic and radiological techniques have slightly been evaluated. A 58 years-old male presented with a 20-cm infected multilocular walled-off necrosis. First, endoscopic-ultrasound guided cystogastrostomy using a lumen-apposing metal stent with further necrosectomy was performed, but the access to distal retroperitoneal collection was average.
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Affiliation(s)
| | - Emilia Ragot
- Surgery, Georges-Pompidou European Hospital, France
| | - Hadrien Alric
- Gastroenterology, Georges-Pompidou European Hospital, France
| | | | - Hédi Benosman
- Gastroenterology, Georges-Pompidou European Hospital, France
| | | | - Gabriel Rahmi
- Gastroenterology, Georges-Pompidou European Hospital, France
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