Walled off pancreatic necrosis

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Walled off pancreatic necrosis is a complication of acute pancreatitis that usually occurs more than 4 weeks after acute pancreatitis.[1]

Treatment

Options include[2]:

  • Lumen-apposing metal stents (LUMS)[3]
  • open surgical necrosectomy
  • minimally invasive surgical necrosectomy
  • percutaneous catheter drainage
  • endoscopic transgastric/transluminal drainage
  • direct endoscopic transgastric/transluminal necrosectomy
  • nasocystic drainage

A randomized controlled trial is underway to compare transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach.[4]

References

  1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG; et al. (2013). "Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus". Gut. 62 (1): 102–11. doi:10.1136/gutjnl-2012-302779. PMID 23100216.
  2. Gurusamy KS, Belgaumkar AP, Haswell A, Pereira SP, Davidson BR (2016). "Interventions for necrotising pancreatitis". Cochrane Database Syst Rev. 4: CD011383. doi:10.1002/14651858.CD011383.pub2. PMID 27083933.
  3. Sharaiha RZ, Tyberg A, Khashab MA, Kumta NA, Karia K, Nieto J; et al. (2016). "Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis". Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2016.05.011. PMID 27189914.
  4. van Brunschot S, van Grinsven J, Voermans RP, Bakker OJ, Besselink MG, Boermeester MA; et al. (2013). "Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711]". BMC Gastroenterol. 13: 161. doi:10.1186/1471-230X-13-161. PMC 4222267. PMID 24274589.