ENDOSCOPIC THERAPY FOR ORGANIZED PANCREATIC NECROSIS

Background & Aims: The treatment of patients with extensive pancreatic necrosis remains controversial; a subpopulation of patients with exte nsive acute pancreatic necrosis develop complex, organized collections , This study examined the feasibility of endoscopic drainage in patien ts with extensive organized pancreatic necrosis, Methods: Eleven patie nts with organized pancreatic necrosis (8 sterile and 3 infected) afte r severe acute necrotizing pancreatitis underwent attempted endoscopic drainage, Dynamic contrast-enhanced computerized tomography showed gr eater than or equal to 50% pancreatic necrosis in 10 of 11 patients in whom endoscopic drainage was performed, In 8 patients, an intrapancre atic nasobiliary ravage catheter was placed into the collection concur rently with 10F stents, Results: Complete resolution was achieved nono peratively in 9 patients. At a mean follow-up of 12 months, 1 patient developed a pseudocyst, which was successfully drained endoscopically, Complications occurred in 5, including bleeding that precluded entry into one collection, Conclusions: Endoscopic therapy may be a viable m anagement option for a subset of patients who remain symptomatic after an episode of acute pancreatic necrosis after the necrosis has become organized and partially liquefied, Intrapancreatic lavage catheter pl acement is essential to the success of this procedure, Further evaluat ion of this technique is needed before this method can be adopted into clinical practice.