Gornals Joan B, Consiglieri Claudia F, Busquets Juli, Salord Silvia, de-la-Hera Meritxell, Secanella Lluis, Redondo Susana, Pelaez Nuria, Fabregat Joan
Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Catalonia, Spain.
Department of Surgery, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Surg Endosc. 2016 Jun;30(6):2592-602. doi: 10.1007/s00464-015-4505-2. Epub 2015 Sep 3.
Endoscopic management of walled-off pancreatic necrosis (WOPN) is an area of great interest with many still unanswered questions, including the role of mechanical necrosectomy versus irrigation. The aim of this study was to evaluate a new method of endoscopic transmural necrosectomy.
Patients with WOPN after necrotizing pancreatitis, who underwent endoscopic transmural necrosectomy using a lumen-apposing metal stent with vigorous irrigation sessions, were prospectively recruited between September 2011 and August 2014. Initial endoscopic session was performed by EUS-guided drainage and lavage sessions by flushing saline through the stent. Technical and clinical success rates, number of repeat interventions, and adverse events were analyzed.
Twelve patients with 13 WOPN collections (median size 12.4 ± 2.94 cm) underwent endoscopic treatment. Clinical success was achieved in 100 % of cases after a median of three sessions per patient (range 2-8). The median length of hospitalization was 15.9 days. Median procedure time of the access session was 31 ± 10.16 min. No adverse events (AE) were described during the procedures or 24 h after. There were four AE (two infections and two bleedings) between sessions, but only two were severe (16.6 %). There was no need for surgery, and no mortalities occurred. Mean time to stent retrieval was 9 ± 3.4 weeks. Mean follow-up was 13 months with only one recurrence at 12 months after stent removal.
This new variant of irrigation endoscopic transmural necrosectomy without mechanical debridement helps to simplify the technique, is feasible, and has excellent outcomes in WOPN treatment.
壁内胰腺坏死（WOPN）的内镜治疗是一个备受关注的领域，仍有许多问题未得到解答，包括机械性坏死组织清除术与灌洗的作用。本研究的目的是评估一种新的内镜经壁坏死组织清除术方法。
2011年9月至2014年8月期间，前瞻性招募了坏死性胰腺炎后发生WOPN且接受使用管腔贴附金属支架并进行强力灌洗的内镜经壁坏死组织清除术的患者。初始内镜检查通过超声内镜引导下引流进行，通过支架冲洗生理盐水进行灌洗。分析技术成功率、临床成功率、重复干预次数和不良事件。
12例患者的13个WOPN病灶（中位大小12.4±2.94cm）接受了内镜治疗。每位患者中位进行3次治疗（范围2 - 8次）后，100%的病例取得了临床成功。中位住院时间为15.9天。进入治疗阶段的中位操作时间为31±10.16分钟。术中及术后24小时内未发生不良事件。两次治疗之间发生了4例不良事件（2例感染和2例出血），但只有2例严重（16.6%）。无需进行手术，也未发生死亡。支架取出的平均时间为9±3.4周。平均随访13个月，支架取出后12个月仅有1例复发。
这种不进行机械清创的灌洗内镜经壁坏死组织清除术新方法有助于简化技术，可行且在WOPN治疗中具有出色的效果。
