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Copyright ©The Author(s) 2022.
World J Gastrointest Surg. Aug 27, 2022; 14(8): 731-742
Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.731
Table 1 Case series of percutaneous direct endoscopic necrosectomy for infected pancreatic necrosis
Ref.
Number of patients
Initial intervention
PDEN/stent assisted PDEN
Anaesthesia
Median PDEN sessions
Additional intervention-number of patients
Clinical success rate (%)
Procedure related complications-number of patients
Mortality (%)
Carter et al[11], 200014ON-4, PD-10PDENGA2Surgery-185.7Bleeding-114.3
Mui et al[12], 200513ON-4, PD-10PDENTIVA3ERCP-9, Surgery-176.9Colonic perforation-1; catheter dislodgement-17.7
Dhingra et al[14], 201515PD-15PDENTIVA4Surgery-193.3Bleeding-1; pancreatico-cutaneous Fistula-16.7
Mathers et al[15], 201610PD-10PDENTIVA; GA if clinically warranted1.5None100Pancreatico-cutaneous Fistula-10
Goenka et al[18], 201810PD-10PDENTIVA2.3Transmural, DEN-2, Surgery-190Pneumo-peritoneum-20
Saumoy et al[19], 20189PD-9Stent-assisted PDENGA3None88.9None11.1
Thorsen et al[20], 20185PD-3; transmural; DEN-2Stent-assisted PDENTIVA or GA6Transmural DEN-180Abdominal Pain-5; pancreatico-cutaneous fistula-220
Tringali et al[21], 20183PD-3Stent-assisted PDENTIVA30100None0
Jain et al[5], 202053PD-53PDENTIVA4Surgery-879.2Pancreatico-cutaneous fistula-4; bleeding-1; aspiration pneumonia-2; peritonitis-2; paralytic ileus-1; subcutaneous emphysema-120.8
Ke et al[25], 202137PD-37Stent-assisted PDENNA4Surgery-886.5Bleeding-6; pancreatico-cutanoeus fistula-7; colonic fistula-4; gastro-duodenal fistula-413.5
Table 2 Indications of percutaneous direct endoscopic necrosectomy
Indications
< 2-4 wk-Infected acute pancreatic/peripancreatic collection in which percutaneous drainage is required early and infection persists even after percutaneous drainage alone
> 2-4 wk-Infected walled off pancreatic necrosis unsuitable for transmural drainage: (1) Location (Paracolic/pelvic extension); (2) Distance > 1 cm; (3) Coagulopathy; (4) Multiple collaterals-Endosonography guided can be done
Table 3 Advantages and disadvantages of percutaneous direct endoscopic necrosectomy
No.
Advantages
Disadvantages
1It can be done in critically ill patients where laparoscopy access is not possible- bed sideMore invasive (compared to transmural necrosectomy) (Multiple interventions-percutaneous drainage followed by multiple tract dilation/drainage catheter exchanges, if not stent-assisted percutaneous direct endoscopic necrosectomy)
2Subsequent liquefied necrosis drained by gravitySmall endoscopic accessories for necrosectomy-hence, time-consuming and labour-intensive procedure (compared to VARD/surgical necrosectomy)
3No intraperitoneal transmission (retroperitoneal approach); a fully covered self-expandable metal stent may help to prevent intraperitoneal transmission in transperitoneal approachThe need for repeated procedures for effective drainage (compared to VARD/surgical necrosectomy)
4Access various extensions deep within the abdomen using the flexible endoscope’s angulation and versatility (Figures 3C and 6C)Pancreatico-cutaneous fistula (compared to transmural necrosectomy)
5Usually carried out under deep sedation; general anaesthesia avoided-