Patil Gaurav, Maydeo Amit, Dalal Ankit, Iyer Arun, More Rajdeep, Thakare Shivaji
Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India.
GE Port J Gastroenterol. 2021 Jan 22;28(6):425-430. doi: 10.1159/000510025. eCollection 2021 Nov-Dec.
Infected walled-off pancreatic necrosis (WOPN) is a severe complication of acute pancreatitis. Surgery in these critically ill patients can be associated with increased morbidity and mortality. Hence, minimally invasive therapies have emerged as an alternative to surgery. Herein, we report a case of severe acute pancreatitis with WOPN which was treated percutaneously with a flexible endoscope through an esophageal self-expanding metal stent using a total retroperitoneal approach. Percutaneous direct endoscopic necrosectomy (p-DEN) using the retroperitoneal route improved the patient's parameters dramatically with resolution of sepsis without the need for surgery. p-DEN using a flexible endoscope passed through a large bore metal stent shows promise in selected patients with WOPN and can be used in patients who are not ideal candidates for transmural or surgical drainage.
感染性包裹性胰腺坏死（WOPN）是急性胰腺炎的一种严重并发症。对这些重症患者进行手术可能会增加发病率和死亡率。因此，微创治疗已成为手术的替代方法。在此，我们报告一例伴有WOPN的严重急性胰腺炎病例，该病例通过经食管自膨式金属支架采用全腹膜后途径经皮使用软性内镜进行治疗。采用腹膜后途径的经皮直接内镜坏死组织清除术（p-DEN）显著改善了患者的各项指标，脓毒症得以缓解，无需进行手术。通过大口径金属支架置入软性内镜进行p-DEN，对于选定的WOPN患者显示出前景，可用于那些不适合进行透壁引流或手术引流的患者。
