Combined sinus tract endoscopy and endoscopic retrograde cholangiopancreatography in management of pancreatic necrosis and abscess

• Published in: Surgical endoscopy Vol. 19; no. 3; pp. 393 - 397
• Main Authors: MUI, L. M, WONG, S. K. H, NG, E. K. W, CHAN, A. C. W, CHUNG, S. C. S
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01-03-2005; Springer Nature B.V
• Subjects: Abscess - surgery; Abscesses; Adult; Aged; Aged, 80 and over; Anesthesia; Antibiotics; Biological and medical sciences; Catheters; Cholangiopancreatography, Endoscopic Retrograde; Combined Modality Therapy; Debridement; Digestive system; Endoscopy; Endoscopy, Digestive System; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Necrosis; Pancreatic Diseases - surgery; Pancreatitis; Pancreatitis, Acute Necrotizing - surgery; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sinuses; Cholangiopancreatography; Clinical management; Radiodiagnosis; sinus tract endoscopy; Abscess; pancreatic abscess; ERCP; pancreatic necrosis; Endoscopy; Pancreas; Necrosis
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-004-9120-6

We report our experience of sinus tract endoscopy (STE) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of pancreatic necrosis and abscess.
Thirteen patients with extensive pancreatic necrosis were firstly managed with either percutaneous drainage (PD group; n = 9) or open necrosectomy (ON group; n = 4). Debridement of necrotic tissue was subsequently performed via the drain tract by STE. ERCP was performed only when there was a suspicious of persistent pancreatic duct disruption or choledocholithiasis.
In the PD group, the median number of STE sessions required was 3 (range 2-8). The median hospital and ICU stay were 84 days (range 29-163 days) and 0 day (range 0-64 days), respectively, with an overall success rate of 67%. In the ON group, the median number of STE sessions required was 6.5 (range 1-18). The median hospital and ICU stay were 82 days (range 58-194 days) and 19 days (range 4-24 days), respectively. No mortality or failure was noted in the latter group. ERCP was required in nine of 13 patients.
Combined ERCP and STE is a useful adjunct in treating pancreatic necrosis or abscess.