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Long-term Outcomes of Direct Endoscopic Necrosectomy for Complicated or Symptomatic Walled-Off Necrosis: A Korean Multicenter Study

 Yeon Suk Kim  ;  Jae Hee Cho  ;  Dong Hui Cho  ;  Se Woo Park  ;  Sung-Hoon Moon  ;  Jin-Seok Park  ;  Yun Nah Lee  ;  Sang Soo Lee 
 GUT AND LIVER, Vol.15(6) : 930-939, 2021-11 
Journal Title
Issue Date
Acute Disease ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Necrosis ; Pancreatitis, Acute Necrotizing* / surgery ; Republic of Korea ; Retrospective Studies ; Stents* ; Treatment Outcome
Acute pancreatitis ; Antibiotics ; Endoscopy ; Infected necrosis ; Necrosectomy
Background/aims: The endoscopic step-up approach is accepted as the preferred treatment for complicated or symptomatic walled-off necrosis (WON). Direct endoscopic necrosectomy (DEN) is an effective therapeutic option, but few reports describe long-term follow-up in this patient population. Thus, we aim to assess the long-term outcomes of DEN following severe necrotizing pancreatitis.

Methods: The data of all acute pancreatitis patients who underwent DEN following endoscopic transmural drainage from six referral centers between 2007 and 2017 were retrospectively collected.

Results: Sixty patients (76.7% male, mean age 48.3 years) underwent a median of 4 sessions of DEN starting at a median of 45.5 days after the onset of acute pancreatitis. Clinical success was achieved in 51 patients (85%), with a 35% complication rate and a 5% mortality rate. Using multivariate analysis, the risk factor associated with DEN failure or major DEN complications requiring intervention or surgery was an identified bacterial/fungal WON infection (odds ratio, 19.3; 95% confidence interval, 1.5 to 261.7). During the median follow-up period of 27 months, complicated WON recurrence was observed in 5.3% of patients, and long-term complications occurred in 24.6% of patients (four exocrine insufficiency, nine newly developed diabetes mellitus, one recurrent small bowel obstruction, one chylous ascites).

Conclusions: Considering that long-term complications are similar to those observed after pancreatectomy, DEN should be performed meticulously while minimizing damage to the viable pancreatic parenchyma with adequate antibiotic escalation.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Cho, Jae Hee(조재희) ORCID logo https://orcid.org/0000-0003-4174-0091
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