Mendoza Ladd Antonio, Bashashati Mohammad, Contreras Alberto, Umeanaeto Onyedika, Robles Alejandro
Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX 79905, United States.
Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX 79905, United States.
World J Gastrointest Endosc. 2020 May 16;12(5):149-158. doi: 10.4253/wjge.v12.i5.149.
A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy (DEN) for pancreatic walled-off necrosis (WON). However, significant technical heterogeneity still exists among endoscopists.
To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous studies.
Medical records of patients with WON who underwent DEN from September 2016 - May 2019 were queried for the following information: Age, gender, ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events (AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent (LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months (mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables, frequency and proportion for categorical variables, and median and range for interval data.
A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance, dilated the same day of deployment and removed after a mean of 27 ± 11 d. Routine cross-sectional imaging immediately after drainage was not performed. The mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis (2), stent migration (1), stent maldeployment (1), perforation (1). The sensitivity and positive predictive value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No fatalities were observed.
Our DEN technique differed significantly from the one recommended by a recent expert panel and the one published in previous studies. Despite these differences excellent clinical outcomes were obtained.
最近一个专家小组发布了关于胰腺壁内坏死（WON）直接内镜坏死组织清除术（DEN）技术方面的建议。然而，内镜医师之间仍存在显著的技术异质性。
报告我们的DEN技术的结果，以及它与最近的专家共识声明和先前研究有何不同。
查询2016年9月至2019年5月接受DEN的WON患者的病历，获取以下信息：年龄、性别、种族、急性胰腺炎的病因、WON的位置和大小、DEN技术信息、不良事件（AE）和结果。不良事件根据美国胃肠内镜学会词汇分级系统进行分级。技术成功定义为放置合适的管腔对合金属支架（LAMS）并清除≥90%的坏死组织。临床成功定义为通过影像学检查WON腔完全消失，且在最后一次DEN后≤3个月（mo）症状消失。连续变量采用均值和标准差进行数据分析，分类变量采用频率和比例进行数据分析，区间数据采用中位数和范围进行数据分析。
共有21例患者接受了DEN。他们大多是西班牙裔，平均年龄为51±17岁。大多数积液位于胰体部，平均大小为13 cm±5 cm。最常见的指征是持续呕吐。仅在感染性坏死的病例中使用抗生素。所有LAMS均在无放射学引导下放置，放置当天扩张，平均27±11 d后取出。引流后未立即进行常规横断面成像。DEN疗程之间的平均间隔为7±4 d，每位患者DEN的平均次数为3±2次。技术成功率和临床成功率均为95%。5例患者出现AE，包括：脓毒症（2例）、支架移位（1例）、支架放置不当（1例）、穿孔（1例）。阻塞的LAMS导致脓毒症的敏感性和阳性预测值分别为50%和0.11。未观察到死亡病例。
我们的DEN技术与最近一个专家小组推荐的技术以及先前研究中发表的技术有显著差异。尽管存在这些差异，但仍获得了优异的临床结果。
