Endoscopic transluminal necrosectomy in patients with acute infected necrotizing pancreatitis. Experience of a specialized center

Abstract

Over the past decades, the treatment of acute infected necrotizing pancreatitis (AINP) has significantly improved due to a better understanding of the disease pathogenesis and the implementation of minimally invasive technologies. Endoscopic transluminal interventions occupy an important place among these techniques and continue to evolve, both technically and tactically.

Objective – to evaluate the results of ETN in the treatment of patients with acute infected necrotizing pancreatitis (AINP) and summarize the experience of our department, including technical and tactical aspects of the procedure.

Materials and methods. The study included 28 patients: 15 (53.6%) men and 13 (46.4%) women with a mean age of 52.6±12.5 years, who underwent ETN between 2021 and 2024 due to a limited peri‑/pancreatic necrotic collection in direct contact with the stomach and/or duodenum. AINP of moderate severity was diagnosed in 19 (67.9%) patients, and a severe course – in 9 (32.1%). The mean size of the walled‑off pancreatic necrosis (WON) was 109.6±32.9 mm. ETN outcomes were assessed as complete, partial, or no clinical success.

Results. The first ETN session was performed on average on day 36.2±16.1 (range: 22 to 86 days) from the onset of the disease. A total of 48 ETN sessions were performed, from 1 to 4 per patient, most often a single session in 14 (50.0%) patients. The intervals between subsequent sessions were mostly 6 – 7 days. Continuous lavage of the WON cavity was performed in 17 (60.7%) patients. The duration of each procedure ranged from 60 to 90 minutes. The rate of intraoperative complications was 3.6% (n=1, profuse bleeding). Complete clinical success was achieved in 18 (64.3%) patients, partial success – in 8 (28.6%), and no clinical success – in 2 (7.1%) patients. Overall, 25 (89.3%) patients recovered, and the mortality rate was 10.7% (3 cases).

Conclusions. In 64.3% of cases, ETN can be the main treatment method in AINP when the indications for the procedure are observed. In 28.6% of patients, it serves as a transitional stage before more invasive surgical procedures. Performing ETN with subsequent continuous lavage of the WON cavity increases the likelihood of achieving complete clinical success by 2.26 times compared to patients without lavage (RR 2.26; 95% CI 1.01 – 5.10; p=0.0485).