A Transoral Approach for Draining Fluid in Pancreatic Necrosis
A Transoral Approach for Draining Fluid in Pancreatic Necrosis
Papachristou GI, Takahashi N, Chahal P, et al.
Ann Surg 2007;245:943-951
The authors describe a novel method for draining sterile and infected fluid and tissue contained in walled-off areas of pancreatic necrosis. The method uses a transoral endoscopic approach in selected patients where the walled-off fluid collection presses against the stomach or duodenum. After entering the stomach, the operator punctures the fluid collection and then dilates the opening, allowing access to the material within the pancreas. From 1998 to 2006, 53 patients underwent this procedure after a median interval of 49 days from the onset of pancreatitis. Multiple drainage procedures were often required (median = 3). The drainage procedure was successful in 43 patients.
This technique has been used for the management of pancreatic pseudocysts and the authors now present data to support its use for draining walled-off pancreatic fluid collections. This transoral approach -- rather than external drainage either by a surgical or a radiologic approach -- allows the necrotic material to be evacuated directly into the stomach. The procedure avoids opening the abdomen, thereby reducing the chances for a pancreatic fistula. Careful patient selection is important, but in this series, 12 of the original 53 patients (23%) required an operative procedure. As in other drainage methods, it is necessary to wait a few weeks after the attack of pancreatitis before attempting this approach.
Abstract
Papachristou GI, Takahashi N, Chahal P, et al.
Ann Surg 2007;245:943-951
The authors describe a novel method for draining sterile and infected fluid and tissue contained in walled-off areas of pancreatic necrosis. The method uses a transoral endoscopic approach in selected patients where the walled-off fluid collection presses against the stomach or duodenum. After entering the stomach, the operator punctures the fluid collection and then dilates the opening, allowing access to the material within the pancreas. From 1998 to 2006, 53 patients underwent this procedure after a median interval of 49 days from the onset of pancreatitis. Multiple drainage procedures were often required (median = 3). The drainage procedure was successful in 43 patients.
This technique has been used for the management of pancreatic pseudocysts and the authors now present data to support its use for draining walled-off pancreatic fluid collections. This transoral approach -- rather than external drainage either by a surgical or a radiologic approach -- allows the necrotic material to be evacuated directly into the stomach. The procedure avoids opening the abdomen, thereby reducing the chances for a pancreatic fistula. Careful patient selection is important, but in this series, 12 of the original 53 patients (23%) required an operative procedure. As in other drainage methods, it is necessary to wait a few weeks after the attack of pancreatitis before attempting this approach.
Abstract
