Combined endoscopic and percutaneous drainage of organized pancreatic necrosis

Background: Severe acute pancreatitis is often complicated by organized necrosis, which call lead to abscess formation and clinical deterioration. We sought to devise a combined endoscopic and percutaneous approach 10 drainage of organized pancreatic necrosis, with the primary goal of preventing the formation of chronic pancreaticocutatneous fistulae, and secondary goals of avoiding the need for Surgical necrosectomy and reducing endoscopic resource utilization. Design: Retrospective review of an institutional review board-approved database. Setting: Single North American tertiary referral center. Patients: Patients with severe acute pancreatitis complicated by organized necrosis requiring drainage. Interventions: CT-guided percutaneous drain, followed immediately by endoscopic transenteric drainage Main Outcome Measurements: Development of chronic pancreaticutaenous fistulae, number Of endoscopic procedures requiring follow-up drainage, need for Surgical necrosectomy, procedure-related morbidity and mortality Results: Fifteen patients (12 males, 3 females; mean age, 58 years) underwent combined modality drainage. All procedures were technically Successful. Immediate complications included fever and hypotension (n = 2); late complications included parenchymal infection after drain removal (n = 1). Twenty-five total endoscopies (4 for drain Manipulation) were performed in the Cohort Subsequent to the initial drainage. After a median duration Of follow-up of 189 days, percutaneous drains were removed in all 13 patients in whom this was attempted no patients had development of chronic pancreaticocutaneous fistulae. There were no deaths, and no patients required Surgery. Limitations: Highly selected patient population, lack of comparison group, single-center experience. Conclusions: In some highly selected patients with infected or symptomatic organized pancreatic necrosis, combined modality drainage results in favorable Clinical outcomes with low associated, procedure-related morbidity. Pancreaticocutaeneous fistulae and Surgical necrosectomy were avoided with minimal endoscopic resource utilization. (Gastrointest Endosc 2010;71:79-84.)