What is the Impact of the Proportion of Solid Necrotic Content on the Number of Necrosectomies during EUS-Guided Drainage using Lumen-Apposing Metallic Stents of Pancreatic Walled-off Necrosis ?

Authors

  • Andrada Seicean Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca; Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
  • Cristina Pojoga Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Clinical Psychology and Psychotherapy Department Babes-Bolyai University Cluj- Napoca, Romania
  • Ofelia Mostean Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca; Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
  • Sorana Bolboaca Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
  • Madalina Ilie Carol Davila University of Medicine and Pharmacy, Bucharest; Floreasca Emergency Hospital, Bucharest, Romania
  • Mihai Rimbas Carol Davila University of Medicine and Pharmacy, Bucharest; Colentina Clinical Hospital, Bucharest, Romania
  • Marcel Gheorghiu Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
  • Laura Lucaciu Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
  • Adrian Bartos Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca; Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
  • Nadim Al Hajjar Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca; Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
  • Vasile Sandru Carol Davila University of Medicine and Pharmacy, Bucharest; Floreasca Emergency Hospital, Bucharest, Romania
  • Gabriel Constantinescu Carol Davila University of Medicine and Pharmacy, Bucharest; Floreasca Emergency Hospital, Bucharest, Romania
  • Radu Seicean Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca; First Surgical Clinic, Cluj-Napoca, Romania

DOI:

https://doi.org/10.15403/jgld-3128

Keywords:

endosonography, drainage, pancreatic necrosis, metallic stent, acute pancreatitis

Abstract

Background and Aims: The fully-covered, lumen apposing metal stents are designed for one step placement, facilitating the direct endoscopic necrosectomy into the walled-off pancreatic necrosis. However, the prediction of the number of necrosectomy sessions in these patients is not known. This study evaluated the association between the proportion of solid necrotic material inside walled-off necrosis, as assessed during the endosonography placement of a lumen apposing metal stent, and the number of necrosectomies subsequently required.

Methods: Patients from three tertiary medical centers with symptomatic walled off pancreatic necrosis (pain, infection, gastric/biliary obstruction) at more than 4 weeks after onset of acute pancreatitis were retrospectively analysed. Proportion of solid necrotic debris was estimated during endosonography procedure of lumen apposing metal stents placement. Necrosectomy was performed when obstruction or inflammation occurred subsequently. Lumen apposing metal stents were removed after clearance of necrotic content.

Results: In 46 patients with successful lumen apposing metal stents placement, necrosectomy was performed in 39 patients (72.78%). Performance of 3 or more necrosectomies was significantly associated with more than 50% pancreatic necrosis (p=0.032), but not with walled-off pancreatic necrosis size or location. Necrotic infection during lumen apposing metal stents stenting was associated with hypoalbuminemia, but not with necrosectomy requirement. Clinical success after a median follow-up of 13.37 months was 87%.

Conclusions: Walled-off pancreatic necrosis with more than 50% solid necrotic content were associated with more necrosectomy procedures, requiering longer endoscopy time, intravenous sedations, and higher costs.

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Published

2020-12-12

How to Cite

1.
Seicean A, Pojoga C, Mostean O, Bolboaca S, Ilie M, Rimbas M, Gheorghiu M, Lucaciu L, Bartos A, Al Hajjar N, Sandru V, Constantinescu G, Seicean R. What is the Impact of the Proportion of Solid Necrotic Content on the Number of Necrosectomies during EUS-Guided Drainage using Lumen-Apposing Metallic Stents of Pancreatic Walled-off Necrosis ?. JGLD [Internet]. 2020 Dec. 12 [cited 2025 Jul. 14];29(4):623-8. Available from: https://jgld.ro/jgld/index.php/jgld/article/view/3128

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Original Article