Open AccessEndoscopic treatment with transmural drainage and necrosectomy for walled‐off necrosis provides favourable long‐term outcomes on pancreatic function
Author(s) -
Bartholdy Andreas,
Werge Mikkel,
Novovic Srdan,
Hadi Amer,
Nøjgaard Camilla,
Borch Anders,
Feldager Erik,
Gluud Lise Lotte,
Schmidt Palle Nordblad
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620916029
Subject(s) - medicine , odds ratio , surgery , confidence interval , gastroenterology , pancreatic duct , acute pancreatitis , pancreatitis
Background and aims Several studies have shown improved short‐term outcome with endoscopic transmural drainage and necrosectomy for the treatment of walled‐off pancreatic necrosis. However, knowledge on the long‐term prognosis after such treatment is limited. The aim of present study was to evaluate long‐term outcomes in patients endoscopically treated with transmural drainage and necrosectomy. Methods We retrospectively follow up 125 patients with walled‐off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy in 2010–2017. All patients received plastic pigtail stents and nasocystic catheter. Additional external drainage was performed in 41 patients. Main outcomes were survival, pancreatic function, development of co‐morbidities, ability to work and social status. Results During a median follow‐up of 4.3 years, nine (7%) patients died. Seven deaths were unrelated to pancreatic disease, and two patients died of pancreatic cancer. Twenty‐two (18%) patients developed exocrine pancreatic insufficiency. Thirty‐six (32%) previous non‐diabetics developed endocrine insufficiency. Endoscopic necrosectomy during admission (odds ratio (OR) = 1.28, 95% confidence interval (CI) 1.05–1.56; p = 0.015) and therapy on the main pancreatic duct (OR = 8.08, 95% CI 2.43–26.9; p < 0.001) during follow‐up predicted development of exocrine insufficiency. Severity on computed tomography predicted endocrine insufficiency (OR = 1.61, 95% CI 1.24–2.09; p < 0.001). Most patients regained their working capacity and preserved their marital status. Conclusions This study provides robust data on the long‐term outcome of patients with walled‐off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy. The favourable outcomes on survival, pancreatic function and social status support current recommendations of endoscopic transmural drainage and necrosectomy being the treatment of choice for walled‐off pancreatic necrosis.