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Endoscopic treatment with transmural drainage and necrosectomy for walled-off necrosis provides favourable long-term outcomes on pancreatic function.
- Source :
-
United European gastroenterology journal [United European Gastroenterol J] 2020 Jun; Vol. 8 (5), pp. 552-558. Date of Electronic Publication: 2020 Apr 23. - Publication Year :
- 2020
-
Abstract
- Background and Aims: Several studies have shown improved short-term outcome with endoscopic transmural drainage and necrosectomy for the treatment of walled-off pancreatic necrosis. However, knowledge on the long-term prognosis after such treatment is limited. The aim of present study was to evaluate long-term outcomes in patients endoscopically treated with transmural drainage and necrosectomy.<br />Methods: We retrospectively follow up 125 patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy in 2010-2017. All patients received plastic pigtail stents and nasocystic catheter. Additional external drainage was performed in 41 patients. Main outcomes were survival, pancreatic function, development of co-morbidities, ability to work and social status.<br />Results: During a median follow-up of 4.3 years, nine (7%) patients died. Seven deaths were unrelated to pancreatic disease, and two patients died of pancreatic cancer. Twenty-two (18%) patients developed exocrine pancreatic insufficiency. Thirty-six (32%) previous non-diabetics developed endocrine insufficiency. Endoscopic necrosectomy during admission (odds ratio (OR) = 1.28, 95% confidence interval (CI) 1.05-1.56; p = 0.015) and therapy on the main pancreatic duct (OR = 8.08, 95% CI 2.43-26.9; p < 0.001) during follow-up predicted development of exocrine insufficiency. Severity on computed tomography predicted endocrine insufficiency (OR = 1.61, 95% CI 1.24-2.09; p < 0.001). Most patients regained their working capacity and preserved their marital status.<br />Conclusions: This study provides robust data on the long-term outcome of patients with walled-off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy. The favourable outcomes on survival, pancreatic function and social status support current recommendations of endoscopic transmural drainage and necrosectomy being the treatment of choice for walled-off pancreatic necrosis.
- Subjects :
- Adult
Aged
Aged, 80 and over
Catheters
Drainage instrumentation
Endoscopy instrumentation
Exocrine Pancreatic Insufficiency diagnosis
Exocrine Pancreatic Insufficiency etiology
Exocrine Pancreatic Insufficiency physiopathology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pancreas pathology
Pancreas surgery
Pancreatic Function Tests statistics & numerical data
Pancreatitis, Acute Necrotizing complications
Pancreatitis, Acute Necrotizing mortality
Pancreatitis, Acute Necrotizing physiopathology
Psychological Distance
Retrospective Studies
Stents
Tomography, X-Ray Computed
Treatment Outcome
Young Adult
Drainage methods
Endoscopy methods
Exocrine Pancreatic Insufficiency surgery
Pancreas physiopathology
Pancreatitis, Acute Necrotizing surgery
Subjects
Details
- Language :
- English
- ISSN :
- 2050-6414
- Volume :
- 8
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- United European gastroenterology journal
- Publication Type :
- Academic Journal
- Accession number :
- 32326877
- Full Text :
- https://doi.org/10.1177/2050640620916029