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Pancreatic Necrosectomy Using Covered Esophageal Stents: A Novel Approach

Sarkaria, Savreet MD*; Sethi, Amrita MD; Rondon, Carlos MD*; Lieberman, Michael MD; Srinivasan, Indu MD*; Weaver, Kristen RN*; Turner, Brian G. MD*; Sundararajan, Subha MD*; Berlin, David MD§; Gaidhane, Monica MD*; Rolshud, Daniil MD; Widmer, Jessica DO*; Kahaleh, Michel MD, FASGE*

Journal of Clinical Gastroenterology:
doi: 10.1097/MCG.0b013e3182972219
LIVER, PANCREAS AND BILIARY TRACT: Original Articles
Abstract

Background: Endoscopic necrosectomy for necrotizing pancreatitis has been increasingly used as an alternative to surgical or percutaneous interventions. The use of fully covered esophageal self-expandable metallic stents may provide a safer and more efficient route for internal drainage. The aim of this study was to evaluate the safety and efficacy of endoscopic treatment of pancreatic necrosis with these stents.

Methods: A retrospective study at 2 US academic hospitals included patients with infected pancreatic necrosis from July 2009 to November 2012. These patients underwent transgastric placement of fully covered esophageal metallic stents draining the necrosis. After necrosectomy, patients underwent regular sessions of endoscopic irrigation and debridement of cystic contents. The efficacy endpoint was successful resolution of infected pancreatic necrosis without the need for surgical or percutaneous interventions.

Results: Seventeen patients were included with the mean age of 41±12 years. A mean of 5.3±3.4 sessions were required for complete drainage and the follow-up period was 237.6±165 days. Etiology included gallstone pancreatitis (6), alcohol abuse (6), s/p distal pancreatectomy (2), postendoscopic retrograde cholangiopancreatography pancreatitis (1), medication-induced pancreatitis (1), and hyperlipidemia (1). Mean size of the necrosis was 14.8 cm (SD 5.6 cm), ranging from 8 to 19 cm. Two patients failed endoscopic intervention and required surgery. The only complication was a perforation during tract dilation, which was managed conservatively. Fifteen patients (88%) achieved complete resolution.

Conclusions: Endoscopic necrosectomy with covered esophageal metal stents is a safe and successful treatment option for infected pancreatic necrosis.

Author Information

*Division of Gastroenterology and Hepatology

Department of Surgery

§Intensive Care Unit, Weil Cornell Medical College, Cornell University

Division of Gastroenterology and Hepatology, Columbia University College of Physicians and Surgeons, New York, NY

Accepted and presented as a scientific poster session at Digestive Disease Week—San Diego in May 2012.

S. Sarkaria, A.S., C.R., M.L., I.S., B.G.T., S. Sundararajan, D.B., D.R., J.W.: drafting of the manuscript, critical revision of the manuscript for important intellectual content; K.W.: critical revision of the manuscript for important intellectual content; M.G.: acquisition of data, interpretation of data, critical revision of the manuscript for important intellectual content, study coordination; M.K.: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, study supervision.

M.K. has received grant support from Boston Scientific, Fujinon, EMcison, Xlumena Inc., MaunaKea, and MI Tech. He is a consultant for Xlumena Inc. The remaining authors declare that they have nothing to disclose.

Reprints: Michel Kahaleh, MD, FASGE, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021 (e-mail: mkahaleh@gmail.com).

Received December 18, 2012

Accepted April 9, 2013

© 2014 by Lippincott Williams & Wilkins