Endoscopic necrosectomy for acute necrotizing pancreatitis. a single center retrospective study

Background: Acute necrotizing pancreatitis (ANP) is associated with a high morbidity and mortality. For decades, open surgery was the only treatment for this disease. Surgery is now increasingly replaced by minimally invasive techniques including endoscopic transmural approaches. The aim of this study was to evaluate all endoscopic necrosectomies performed at our department with regard to the safety and efficacy of this technique.

Methods: Patients who had undergone endoscopic necrosectomy were identified retrospectively in examination report databases. Demographic and procedure related parameters were analyzed using descriptive statistics.

Results: Between 2005 and 2012 12 patients (8 male, 4 female, median age 65 years, range 30 – 70 years) underwent a total of 26 endoscopic necrosectomies (24 transgastric, 2 transduodenal) for the treatment of ANP. The etiologies of ANP were idiopathic in 4 cases, biliary in 3 cases, post-ERCP in 2 cases and 1 case each of ethanol-induced, drug-induced and acute attack of chronic pancreatitis. The mean time frame from the onset of symptoms to the first endoscopic intervention was 52 ± 23 days. A median number of 2 endoscopic interventions (range 1 – 4) were necessary for the treatment of necrosis. One case of bloody oozing at the gastric puncture site was the only interventional complication and could be managed endoscopically. Post-interventionally, the mean hospital stay was 27 ± 18 days (calculated from the first endoscopic necrosectomy in each patient). There was no 30-day mortality. Within the further clinical course, 2/12 (17%) study patients had to undergo surgical necrosectomy.

Conclusion: Endoscopic necrosectomy was safe and effective in this study, proved by a low morbidity, mortality and surgical intervention rate. Although the number of cases studied is low, these results are consistent with the findings reported in previous studies on endoscopic necrosectomy.