Mendoza Ladd A, Bashashati M, Contreras A, Umeanaeto O, Robles A. Endoscopic pancreatic necrosectomy in the United States-Mexico border: A cross sectional study. World J Gastrointest Endosc 2020; 12(5): 149-158 [PMID: 32477449 DOI: 10.4253/wjge.v12.i5.149]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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
ARTICLE HIGHLIGHTS
Research background
Currently, no official practice guidelines exist for direct endoscopic necrosectomy (DEN). A recent international expert panel issued recommendations about some of its technical aspects, but they are not universally applied by endoscopists worldwide.
Research motivation
To demonstrate that in DEN, flexibility within acceptable limits does not compromise outcomes.
Research objectives
To describe how our DEN technique differs from recent expert panel recommendations and other previously published studies. To provide an in-depth overview of our DEN technique with detailed description of endoscopes and devices used, as well as of its clinical outcomes and adverse events.
Research methods
Retrospective review of medical records of patients with walled-off necrosis (WON) who underwent DEN. 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 of symptoms at ≤ 3 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.
Research results
Data was collected on 21 patients. The mean age was 51 ± 17 years. The majority of patients were Hispanic and most of the collections were located in the body of the pancreas. 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 number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. Two patients were lost to follow-up. Five patients experienced adverse events, but none were fatal.
Research conclusions
This study showed that endoscopic management of pancreatic WON is a procedure in which technical diversity within acceptable limits does not compromise clinical outcomes. It suggests that antibiotic prophylaxis and complete debridement are not necessary; and that stent occlusion is not unequivocally associated to sepsis.
Research perspectives
Prospective multicenter randomized trials addressing topics such as the optimal interval for LAMS removal, the role of prophylactic antibiotics, cross-sectional imaging and complete debridement of the cavity are needed.
