Vyawahare MA, Gulghane S, Titarmare R, Bawankar T, Mudaliar P, Naikwade R, Timane JM. Percutaneous direct endoscopic pancreatic necrosectomy. World J Gastrointest Surg 2022; 14(8): 731-742 [PMID: 36157371 DOI: 10.4240/wjgs.v14.i8.731]
Corresponding Author of This Article
Manoj A Vyawahare, MD, Chief Doctor, Department of Medical Gastroenterology, American Oncology Institute at Nangia Specialty Hospital, MIDC Hingna, Nagpur 440028, Maharashtra, India. drmanojvyawahare@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2022; 14(8): 731-742 Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.731
Percutaneous direct endoscopic pancreatic necrosectomy
Manoj A Vyawahare, Sushant Gulghane, Rajkumar Titarmare, Tushar Bawankar, Prashant Mudaliar, Rahul Naikwade, Jayesh M Timane
Manoj A Vyawahare, Department of Medical Gastroenterology, American Oncology Institute at Nangia Specialty Hospital, Nagpur 440028, Maharashtra, India
Sushant Gulghane, Jayesh M Timane, Department of Internal Medicine and Critical Care, American Oncology Institute at Nangia Specialty Hospital, MIDC Hingna, Nagpur 440028, Maharashtra, India
Rajkumar Titarmare, Tushar Bawankar, Department of Anaesthesiology, American Oncology Institute at Nangia Specialty Hospital, MIDC Hingna, Nagpur 440028, Maharashtra, India
Prashant Mudaliar, Department of Radiology, American Oncology Institute at Nangia Specialty Hospital, MIDC Hingna, Nagpur 440028, Maharashtra, India
Rahul Naikwade, Department of Surgery, American Oncology Institute at Nangia Specialty Hospital, MIDC Hingna, Nagpur 440028, Maharashtra, India
Author contributions: Vyawahare MA, Gulghane S, Titarmare R, Bawankar T, Mudaliar P, Naikwade R, and Timane JM had substantial contributions to conception and design of the study, and acquisition, analysis, and interpretation of the data, drafted the article or made critical revisions related to important intellectual content of the manuscript, and approved the final version of the article to be published.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: 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/
Corresponding author: Manoj A Vyawahare, MD, Chief Doctor, Department of Medical Gastroenterology, American Oncology Institute at Nangia Specialty Hospital, MIDC Hingna, Nagpur 440028, Maharashtra, India. drmanojvyawahare@gmail.com
Received: April 9, 2022 Peer-review started: April 9, 2022 First decision: May 12, 2022 Revised: May 23, 2022 Accepted: August 5, 2022 Article in press: August 5, 2022 Published online: August 27, 2022 Processing time: 136 Days and 23.5 Hours
Abstract
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.
Core Tip: In expert hands, percutaneous direct endoscopic necrosectomy through the sinus drainage tract, established after percutaneous drainage or surgical necrosectomy drain, plays a vital role as a minimally invasive, safe, and effective adjunct in the management of infected pancreatic necrosis.
