Schrover Ilse M, Weusten Bas L A M, Besselink Marc G H, Bollen Thomas L, van Ramshorst Bert, Timmer Robin
Department of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands.
Pancreatology. 2008;8(3):271-6. doi: 10.1159/000134275. Epub 2008 May 22.
Infected pancreatic and peripancreatic necrosis in acute pancreatitis is potentially lethal, with mortality rates up to 35%. Therefore, there is growing interest in minimally invasive treatment options, such as (EUS-guided) endoscopic transgastric necrosectomy.
Retrospective cohort study on EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis.
8 patients (age 38-75, mean 50 years) with documented infected peripancreatic or pancreatic necrosis were included. Median time to first intervention was 33 days (range 17-62) after onset of symptoms. At the time of first intervention 2 patients had organ failure. All patients were managed on the patient ward. Initial endoscopic drainage was successful in all patients, a median of 4 (range 2-6) subsequent endoscopic necrosectomies were needed to remove all necrotic tissue. Two patients needed additional surgical intervention because of pneumoperitoneum (n = 1) and insufficient endoscopic drainage (n = 1). Six patients recovered, with 1 mild relapse during follow-up (median 12, range 8-60 months). One patient died.
EUS-guided endoscopic transgastric necrosectomy of infected necrosis in acute pancreatitis appears to be a feasible and relatively safe treatment option in patients who are not critically ill. Further randomized comparison with the current 'gold standard' is warranted to determine the place of this treatment modality.
急性胰腺炎合并感染性胰腺及胰周坏死具有潜在致命性，死亡率高达35%。因此，人们对微创治疗方案的兴趣与日俱增，如（超声内镜引导下）内镜经胃坏死组织清除术。
对急性胰腺炎合并感染性坏死患者行超声内镜引导下内镜经胃坏死组织清除术的回顾性队列研究。
纳入8例（年龄38 - 75岁，平均50岁）有记录的感染性胰周或胰腺坏死患者。首次干预的中位时间为症状出现后33天（范围17 - 62天）。首次干预时，2例患者出现器官功能衰竭。所有患者均在病房接受治疗。所有患者初始内镜引流均成功，为清除所有坏死组织，中位需要4次（范围2 - 6次）后续内镜坏死组织清除术。2例患者因气腹（1例）和内镜引流不足（1例）需要额外的手术干预。6例患者康复，随访期间1例轻度复发（中位时间12个月，范围8 - 60个月）。1例患者死亡。
对于病情不严重的急性胰腺炎合并感染性坏死患者，超声内镜引导下内镜经胃坏死组织清除术似乎是一种可行且相对安全的治疗选择。有必要进一步与当前的“金标准”进行随机对照比较，以确定这种治疗方式的地位。
