Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Dig Endosc. 2013 Jan;25(1):47-52. doi: 10.1111/j.1443-1661.2012.01318.x. Epub 2012 Apr 26.
Endoscopic treatment of pancreatic necrosis is less invasive than surgery but is a technically demanding procedure. The aim of the present study was to retrospectively evaluate the safety and efficacy of endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis (WOPN) without the use of fluoroscopy.
Over the last 24 months, 20 patients (16 men) with symptomatic non-bulging WOPN were treated endoscopically at Department of Gastroenterology, PGIMER, Chandigarh, India.The WOPN was transmurally approached using a linear echoendoscope and the tract dilated over the wire and multiple stents and a nasocystic drain were placed.
All 20 patients had acute severe pancreatitis and the etiology of pancreatitis was alcohol in 12, gallstones in six and idiopathic in two patients. All patients were symptomatic with pain and six patients had fever and presented 5 to 16 weeks after an acute episode.The size of WOPN ranged from 5 to 16 cm.All 20 patients had marked improvement with radiological resolution noted in 19 patients and only one patient required direct endoscopic necrosectomy. One patient with multiple WOPN had a large peripherally located WOPN that did not resolve after transmural drainage and required an additional percutaneous drainage. One to seven endoscopic sessions were required and all these patients had complete resolution within 6 weeks.There were no complications of the procedure.There has been no recurrence of symptoms in these patients over a median follow up of 14 months.
EUS-guided transmural drainage of non-bulging WOPN without the use of fluoroscopy appears to be safe and effective.
与手术相比，内镜治疗胰腺坏死的创伤较小，但技术要求较高。本研究旨在回顾性评估在不使用透视的情况下，经内镜超声（EUS）引导对非膨出性包裹性坏死（WOPN）进行经壁引流治疗有症状的非膨出性 WOPN 的安全性和有效性。
在过去的 24 个月中，印度昌迪加尔 PGIMER 胃肠病学部对 20 例（男 16 例）有症状的非膨出性 WOPN 患者进行了内镜治疗。使用线性回声内镜经壁接近 WOPN，并使用导丝扩张通道，放置多个支架和鼻囊肿引流管。
所有 20 例患者均患有急性重症胰腺炎，胰腺炎的病因分别为酒精 12 例、胆石症 6 例和特发性 2 例。所有患者均有症状，表现为疼痛，6 例患者有发热，并在急性发作后 5 至 16 周就诊。WOPN 的大小为 5 至 16 cm 不等。19 例患者的影像学结果有明显改善，仅 1 例患者需要直接内镜下坏死组织清除术。1 例有多发性 WOPN 的患者，其外周部位较大的 WOPN 经经壁引流后未得到缓解，需要额外进行经皮引流。需要 1 至 7 次内镜治疗，所有患者均在 6 周内完全缓解。该操作无并发症。这些患者的中位随访 14 个月后，症状无复发。
在不使用透视的情况下，EUS 引导对非膨出性 WOPN 进行经壁引流似乎是安全且有效的。
