Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2020; 12(5): 149-158
Published online May 16, 2020. doi: 10.4253/wjge.v12.i5.149
Endoscopic pancreatic necrosectomy in the United States-Mexico border: A cross sectional study
Antonio Mendoza Ladd, Mohammad Bashashati, Alberto Contreras, Onyedika Umeanaeto, Alejandro Robles
Antonio Mendoza Ladd, Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX 79905, United States
Mohammad Bashashati, Alberto Contreras, Onyedika Umeanaeto, Alejandro Robles, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX 79905, United States
Author contributions: All authors contributed to the manuscript and approved the final manuscript as submitted.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Review Board.
Informed consent statement: The study was considered exempt from needing to obtain informed consent. The IRB acknowledges that this project meets the criteria for exemption from formal IRB review in accordance with 45 CFR 46.104 (d)(4)(iii). A Waiver of HIPAA Authorization for Research approved under 45 CFR164.512 (i)(2)(ii). (Texas Tech University Health Science Center – El Paso, Institutional Review Board).
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at dr_ladd25@yahoo.com.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Antonio Mendoza Ladd, FACG, FASGE, MD, Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX 79905, United States. dr_ladd25@yahoo.com
Received: March 27, 2020
Peer-review started: March 27, 2020
First decision: April 29, 2020
Revised: May 6, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: May 16, 2020
Processing time: 49 Days and 12 Hours
Abstract
BACKGROUND

A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy (DEN) for pancreatic walled-off necrosis (WON). However, significant technical heterogeneity still exists among endoscopists.

AIM

To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous studies.

METHODS

Medical records of patients with WON who underwent DEN from September 2016 - May 2019 were queried for the following information: Age, gender, ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events (AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent (LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months (mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables, frequency and proportion for categorical variables, and median and range for interval data.

RESULTS

A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance, dilated the same day of deployment and removed after a mean of 27 ± 11 d. Routine cross-sectional imaging immediately after drainage was not performed. The mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis (2), stent migration (1), stent maldeployment (1), perforation (1). The sensitivity and positive predictive value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No fatalities were observed.

CONCLUSION

Our DEN technique differed significantly from the one recommended by a recent expert panel and the one published in previous studies. Despite these differences excellent clinical outcomes were obtained.

Keywords: Endoscopic necrosectomy; Technical differences; Walled-off necrosis; Lumen-apposing metal stents; International consensus; Clinical outcomes

Core tip: Currently, the most commonly accepted treatment for pancreatic walled-off necrosis is direct endoscopic necrosectomy (DEN). Despite recent recommendations by an international expert panel, no endoscopic technique and/or device has been adopted as a gold standard, and significant technical heterogeneity exists among endoscopists. In this study we provide a detailed description of the procedure including endoscopes and devices used; as well as how our technique differs from international recommendations and previous publications on the topic. In a predominantly Hispanic population, our DEN technique achieved excellent clinical outcomes.