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Percutaneous direct endoscopic pancreatic necrosectomy
Approximately 10%-20% of the cases of acute pancreatitis have acute necrotizing pancreatitis. The infection of pancreatic necrosis is typically associated with a prolonged course and poor prognosis. The multidisciplinary, minimally invasive “step-up” approach is the cornerstone of the management of...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453331/ https://www.ncbi.nlm.nih.gov/pubmed/36157371 http://dx.doi.org/10.4240/wjgs.v14.i8.731 |
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author | Vyawahare, Manoj A Gulghane, Sushant Titarmare, Rajkumar Bawankar, Tushar Mudaliar, Prashant Naikwade, Rahul Timane, Jayesh M |
author_facet | Vyawahare, Manoj A Gulghane, Sushant Titarmare, Rajkumar Bawankar, Tushar Mudaliar, Prashant Naikwade, Rahul Timane, Jayesh M |
author_sort | Vyawahare, Manoj A |
collection | PubMed |
description | Approximately 10%-20% of the cases of acute pancreatitis have acute necrotizing pancreatitis. The infection of pancreatic necrosis is typically associated with a prolonged course and poor prognosis. The multidisciplinary, minimally invasive “step-up” approach is the cornerstone of the management of infected pancreatic necrosis (IPN). Endosonography-guided transmural drainage and debridement is the preferred and minimally invasive technique for those with IPN. However, it is technically not feasible in patients with early pancreatic/peripancreatic fluid collections (PFC) (< 2-4 wk) where the wall has not formed; in PFC in paracolic gutters/pelvis; or in walled off pancreatic necrosis (WOPN) distant from the stomach/duodenum. Percutaneous drainage of these infected PFC or WOPN provides rapid infection control and patient stabilization. In a subset of patients where sepsis persists and necrosectomy is needed, the sinus drain tract between WOPN and skin-established after percutaneous drainage or surgical necrosectomy drain, can be used for percutaneous direct endoscopic necrosectomy (PDEN). There have been technical advances in PDEN over the last two decades. An esophageal fully covered self-expandable metal stent, like the lumen-apposing metal stent used in transmural direct endoscopic necrosectomy, keeps the drainage tract patent and allows easy and multiple passes of the flexible endoscope while performing PDEN. There are several advantages to the PDEN procedure. In expert hands, PDEN appears to be an effective, safe, and minimally invasive adjunct to the management of IPN and may particularly be considered when a conventional drain is in situ by virtue of previous percutaneous or surgical intervention. In this current review, we summarize the indications, techniques, advantages, and disadvantages of PDEN. In addition, we describe two cases of PDEN in distinct clinical situations, followed by a review of the most recent literature. |
format | Online Article Text |
id | pubmed-9453331 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-94533312022-09-23 Percutaneous direct endoscopic pancreatic necrosectomy Vyawahare, Manoj A Gulghane, Sushant Titarmare, Rajkumar Bawankar, Tushar Mudaliar, Prashant Naikwade, Rahul Timane, Jayesh M World J Gastrointest Surg Minireviews Approximately 10%-20% of the cases of acute pancreatitis have acute necrotizing pancreatitis. The infection of pancreatic necrosis is typically associated with a prolonged course and poor prognosis. The multidisciplinary, minimally invasive “step-up” approach is the cornerstone of the management of infected pancreatic necrosis (IPN). Endosonography-guided transmural drainage and debridement is the preferred and minimally invasive technique for those with IPN. However, it is technically not feasible in patients with early pancreatic/peripancreatic fluid collections (PFC) (< 2-4 wk) where the wall has not formed; in PFC in paracolic gutters/pelvis; or in walled off pancreatic necrosis (WOPN) distant from the stomach/duodenum. Percutaneous drainage of these infected PFC or WOPN provides rapid infection control and patient stabilization. In a subset of patients where sepsis persists and necrosectomy is needed, the sinus drain tract between WOPN and skin-established after percutaneous drainage or surgical necrosectomy drain, can be used for percutaneous direct endoscopic necrosectomy (PDEN). There have been technical advances in PDEN over the last two decades. An esophageal fully covered self-expandable metal stent, like the lumen-apposing metal stent used in transmural direct endoscopic necrosectomy, keeps the drainage tract patent and allows easy and multiple passes of the flexible endoscope while performing PDEN. There are several advantages to the PDEN procedure. In expert hands, PDEN appears to be an effective, safe, and minimally invasive adjunct to the management of IPN and may particularly be considered when a conventional drain is in situ by virtue of previous percutaneous or surgical intervention. In this current review, we summarize the indications, techniques, advantages, and disadvantages of PDEN. In addition, we describe two cases of PDEN in distinct clinical situations, followed by a review of the most recent literature. Baishideng Publishing Group Inc 2022-08-27 2022-08-27 /pmc/articles/PMC9453331/ /pubmed/36157371 http://dx.doi.org/10.4240/wjgs.v14.i8.731 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/ |
spellingShingle | Minireviews Vyawahare, Manoj A Gulghane, Sushant Titarmare, Rajkumar Bawankar, Tushar Mudaliar, Prashant Naikwade, Rahul Timane, Jayesh M Percutaneous direct endoscopic pancreatic necrosectomy |
title | Percutaneous direct endoscopic pancreatic necrosectomy |
title_full | Percutaneous direct endoscopic pancreatic necrosectomy |
title_fullStr | Percutaneous direct endoscopic pancreatic necrosectomy |
title_full_unstemmed | Percutaneous direct endoscopic pancreatic necrosectomy |
title_short | Percutaneous direct endoscopic pancreatic necrosectomy |
title_sort | percutaneous direct endoscopic pancreatic necrosectomy |
topic | Minireviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453331/ https://www.ncbi.nlm.nih.gov/pubmed/36157371 http://dx.doi.org/10.4240/wjgs.v14.i8.731 |
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