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Clinical Outcomes of the Endoscopic Step-Up Approach With or Without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis
Pattarapuntakul, T.; Charoenrit, T.; Wong, T.; Netinatsunton, N.; Ovartlarnporn, B.; Yaowmaneerat, T.; Tubtawee, T.; Boonsri, P.; Sripongpun, P. Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis. Medicina2023, 59, 569.
Pattarapuntakul, T.; Charoenrit, T.; Wong, T.; Netinatsunton, N.; Ovartlarnporn, B.; Yaowmaneerat, T.; Tubtawee, T.; Boonsri, P.; Sripongpun, P. Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis. Medicina 2023, 59, 569.
Pattarapuntakul, T.; Charoenrit, T.; Wong, T.; Netinatsunton, N.; Ovartlarnporn, B.; Yaowmaneerat, T.; Tubtawee, T.; Boonsri, P.; Sripongpun, P. Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis. Medicina2023, 59, 569.
Pattarapuntakul, T.; Charoenrit, T.; Wong, T.; Netinatsunton, N.; Ovartlarnporn, B.; Yaowmaneerat, T.; Tubtawee, T.; Boonsri, P.; Sripongpun, P. Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis. Medicina 2023, 59, 569.
Abstract
Abstract: Background and objectives: Symptomatic walled-off pancreatic necrosis is a serious local complication of acute necrotising pancreatitis. The endoscopic step-up approach is the standard treatment for symptomatic walled-off pancreatic necrosis; however, adjunctive radiologic percu-taneous drainage for this condition is controversial. This study compared the clinical and radio-logic resolution of walled-off pancreatic necrosis achieved with the endoscopic step-up approach with or without radiology-guided percutaneous drainage. Material and Methods: This retrospective, single-center cohort study enrolled patients with symp-tomatic walled-off pancreatic necrosis who underwent endoscopic transmural drainage (ETD) followed by directed endoscopic necrosectomy (DEN) with or without radiology-guided drainage. A total of 34 patients (endoscopic approach, n=22; combined modality approach, n=12) underwent the endoscopic step-up approach (ETD followed by DEN). Baseline characteristics, clinical success, and resolution of necrosis were compared between groups. Results: All patients achieved symptom resolution from walled-off pancreatic necrosis. The mean patient age was 58.4 years, and 21 (61.8%) were men. After treatment with the endoscopic approach and combined modality approach, clinical success was achieved in 90.9% of patients within 11.5 days, and 66.7% of patients within 16.5 days, respectively. Both the total hospital stay (55 days vs 71 days; p=0.071) and time to complete radiologic resolution were shorter (93 days vs 124 days; p=0.23) in the endoscopic approach group. Conclusion: The endoscopic step-up approach resulted in the clinical resolution of symptomatic walled-off pancreatic necrosis comparable to that of the combined modality drainage. However, the endoscopic approach alone allows higher clinical success, early clinical and radiologic resolution, and a shorter hospital stay.
Medicine and Pharmacology, Gastroenterology and Hepatology
Copyright:
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