Department of Gastroenterology, Changi General Hospital, 2 Simei Street 3, Singapore.
Singapore Med J. 2013 Apr;54(4):206-11. doi: 10.11622/smedj.2013074.
Endoscopic transenteric stenting is the standard treatment for pseudocysts, but it may be inadequate for treating infected collections with solid debris. Surgical necrosectomy results in significant morbidity. Direct endoscopic necrosectomy (DEN), a minimally invasive treatment, may be a viable option. This study examined the efficacy and safety of DEN for the treatment of infected walled-off pancreatic necrosis and infected pseudocysts with solid debris.
This study was a retrospective analysis of data collected from a prospective database of patients who underwent DEN in the presence of infected walled-off pancreatic necrosis or infected pseudocysts with solid debris from April 2007 to October 2011. DEN was performed as a staged procedure. Endoscopic ultrasonography-guided transgastric stenting was performed during the first session for initial drainage and to establish endoscopic access to the infected collection. In the second session, the drainage tract was dilated endoscopically to allow transgastric passage of an endoscope for endoscopic necrosectomy. Outcome data included technical success, clinical success and complication rates.
Eight patients with infected walled-off pancreatic necrosis or infected pseudocysts with solid debris (mean size 12.5 cm; range 7.8-17.2 cm) underwent DEN. Underlying aetiologies included severe acute pancreatitis (n = 6) and post-pancreatic surgery (n = 2). DEN was technically successful in all patients. Clinical resolution was achieved in seven patients. One patient with recurrent collection opted for surgery instead of repeat endotherapy. No procedural complications were encountered.
DEN is a safe and effective minimally invasive treatment for infected walled-off pancreatic necrosis and infected pseudocysts.
内镜经肠内支架置入术是假性囊肿的标准治疗方法，但对于伴有实体碎片的感染性积聚可能不够充分。外科坏死性胰腺切除术会导致显著的发病率。直接内镜下坏死清除术（DEN）作为一种微创治疗方法，可能是一种可行的选择。本研究检查了 DEN 治疗感染性隔离性胰腺坏死和伴有实体碎片的感染性假性囊肿的疗效和安全性。
本研究是对 2007 年 4 月至 2011 年 10 月期间接受 DEN 治疗的感染性隔离性胰腺坏死或伴有实体碎片的感染性假性囊肿患者的前瞻性数据库中收集的数据进行的回顾性分析。DEN 是作为一个分期手术进行的。在第一次治疗中，进行内镜超声引导下经胃置管引流，以进行初始引流并建立内镜进入感染性积聚的通道。在第二次治疗中，经内镜扩张引流通道，允许经胃内镜进入进行内镜下坏死清除。结局数据包括技术成功率、临床成功率和并发症发生率。
8 例伴有感染性隔离性胰腺坏死或伴有实体碎片的感染性假性囊肿的患者（平均大小 12.5cm；范围 7.8-17.2cm）接受了 DEN。潜在病因包括重症急性胰腺炎（n=6）和胰腺手术后（n=2）。所有患者 DEN 均获得技术成功。7 例患者获得临床缓解。1 例复发性积聚患者选择手术而非重复内镜治疗。未发生手术并发症。
DEN 是一种安全有效的微创治疗方法，适用于感染性隔离性胰腺坏死和感染性假性囊肿。
