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Walled off necrosis

Kartik Sampath, Timothy B Gardner
Acute pancreatitis represents one of the most common gastrointestinal illnesses requiring inpatient hospitalization. An estimated twenty percent of these patients eventually develop pancreatic necrosis. Necrosis management consists of surveillance imaging, where necrosectomy is indicated for symptomatic or infected walled off necrosis (WON). Over the past two decades, the standard of care to manage WON has switched from an open operative approach to an endoscopic, minimally-invasive, step-up method [1] [2]...
October 16, 2016: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Georgia Dedemadi, Manolis Nikolopoulos, Ioannis Kalaitzopoulos, George Sgourakis
Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment...
September 14, 2016: World Journal of Gastroenterology: WJG
Ying-Chun Ren, Su-Min Chen, Xiao-Bo Cai, Bai-Wen Li, Xin-Jian Wan
BACKGROUND: Endoscopic ultrasonography-guided drainage has been established as a good treatment modality in the management of walled-off pancreatic necrosis, but the unmanageable infection of postoperation is still a thorny problem due to the poor drainage ability for solid necrotic debris only through transmural stent and nasocystic catheter. AIMS: Introduce a novel therapeutic method, namely endoscopic ultrasonography-guided drainage combined with cyclic irrigation technique in managing patients with walled-off pancreatic necrosis...
September 1, 2016: Digestive and Liver Disease
Avik Sarkar, Ragui Sadek, Matthew Lissauer, Swati Pawa
BACKGROUND: After an acute attack of pancreatitis, walled-off pancreatic fluid collections (PFC) occur in approximately 10 % of cases. Drainage of the cavity is recommended when specific indications are met. Endoscopic drainage has been adopted as the main intervention for symptomatic walled-off PFC. Altered gastric anatomy in these patients poses an interesting challenge. We present the first case of a patient with sleeve gastrectomy who underwent successful endoscopic transduodenal necrosectomy (TDN)...
2016: BMC Obesity
Lyn A Smith, Colin J McKay
The widespread use of cross-sectional imaging has led to an increased frequency of incidentally detected pancreatic cysts. Neoplastic cysts such as mucinous lesions and solid pseudo-papillary neoplasms have malignant potential and therefore the early detection of these lesions presents an opportunity for prevention or early detection and management of pancreatic adenocarcinoma. Serous neoplastic lesions and non-neoplastic pancreatic cysts such as pseudocysts or walled off pancreatic necrosis and are not associated with malignant potential...
December 2016: Minerva Medica
Farid Jalali, Jason Samarasena, John G Lee
Endoscopists are keenly aware of bleeding risks during and immediately after cystgastrostomy and reduce this risk by endoscopic ultrasound guidance to avoid manipulation near major vessels. Bleeding risk associated with cystgastrostomy stent removal after resolution of a pancreatic fluid collection, however, is less evident. We present our experience with bleeding during cystgastrostomy stent removal in a patient with resolved walled-off necrosis and will discuss the significance of unexplained spontaneous upper gastrointestinal bleeding in this setting, which may serve as a warning sign for possible stent erosion into major vessels...
July 2016: ACG Case Reports Journal
Shin Hamada, Atsushi Masamune, Tooru Shimosegawa
Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In Japan, nationwide epidemiological surveys have been conducted every 4 to 5 years by the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labour, and Welfare of Japan. We reviewed the results of the nationwide surveys focusing on the severity assessment and changes in the therapeutic strategy for walled-off necrosis. The severity assessment system currently used in Japan consists of 9 prognostic factors and the imaging grade on contrast-enhanced computed tomography...
July 28, 2016: World Journal of Gastroenterology: WJG
Suman B Koganti, Ravikanth Kongara, Sateesh Boddepalli, Naushad Shaik Mohammad, Venumadhav Thumma, Bheerappa Nagari, R A Sastry
INTRODUCTION: Although surgery is the preferred treatment for grade III&IV pancreatic trauma, there is a growing movement for non-operative management. in blunt pancreatic trauma. Very few studies compare operative versus non-operative management in adult patients. METHODS: Retrospective analysis of a prospectively maintained database was performed from 2004 to 2013 in the department of gastrointestinal surgery, NIMS, Hyderabad. Comparative analysis was performed between patients who failed versus those who were successfully managed with non-operative management...
September 2016: Annals of Medicine and Surgery
Ali A Siddiqui, Thomas E Kowalski, David E Loren, Ammara Khalid, Ayesha Soomro, Syed M Mazhar, Laura Isby, Michel Kahaleh, Kunal Karia, Joseph Yoo, Andrew Ofosu, Beverly Ng, Reem Z Sharaiha
BACKGROUND AND AIMS: Endoscopic transmural drainage/debridement of pancreatic walled-off necrosis (WON) has been performed using double-pigtail plastic (DP), fully covered self-expanding metal stents (FCSEMSs), or the novel lumen-apposing fully covered self-expanding metal stent (LAMS). Our aim was to perform a retrospective cohort study to compare the clinical outcomes and adverse events of EUS-guided drainage/debridement of WON with DP stents, FCSEMSs, and LAMSs. METHODS: Consecutive patients in 2 centers with WON managed by EUS-guided debridement were divided into 3 groups: (1) those who underwent debridement using DP stents, (2) debridement using FCSEMSs, (3) debridement using LAMSs...
August 24, 2016: Gastrointestinal Endoscopy
Ji Young Bang, Shyam Varadarajulu
OBJECTIVES: Data on the endoscopic treatment outcomes for walled-off necrosis (WON) in children are limited. The aim of the present study was to evaluate the efficacy and safety of endoscopic approach for the treatment of WON in children. METHODS: A retrospective study was conducted of all children with symptomatic WON treated endoscopically over 6 years. Treatment consisted of endoscopic ultrasound-guided transmural drainage using either a lumen-apposing metal stent or multiple 7Fr double pigtail plastic stents with or without percutaneous drainage...
September 2016: Journal of Pediatric Gastroenterology and Nutrition
Ji Young Bang, Udayakumar Navaneethan, Muhammad K Hasan, Robert H Hawes, Shyam Varadarajulu
BACKGROUND AND STUDY AIMS: Although the diagnostic features of disconnected pancreatic duct syndrome (DPDS) by computed tomography (CT) and magnetic/endoscopic retrograde cholangiopancreatography (MRCP/ERCP) have been established, no such characterization exists for endoscopic ultrasound (EUS). This study describes the imaging features of EUS that accurately define DPDS. PATIENTS AND METHODS: This is a prospective study comprising 21 of 42 patients who underwent EUS-guided drainage of walled-off necrosis (WON) over an 18-month period...
August 2016: Endoscopy International Open
Mikkel Werge, Stine Roug, Srdan Novovic, Palle Nordblad Schmidt, Erik Feldager Hansen, Jenny Dahl Knudsen
OBJECTIVES: This study aimed to evaluate the influence of fungal infection and antifungal treatment on outcome in patients with walled-off pancreatic necrosis (WON). METHODS: A retrospective description of fungal infections in a cohort of consecutive patients undergoing endoscopic, transmural drainage and necrosectomy for WON, treated in a tertiary referral center was reviewed. RESULTS: Between 2005 and 2013, fungal infection in WON was documented in 57 (46%) of 123 patients...
November 2016: Pancreas
Bulent Odemis, Erkin Oztas, Muhammet Yener Akpinar, Sabite Kacar, Ufuk Baris Kuzu, Mustafa Ozdemir
No abstract text is available yet for this article.
2016: Endoscopy
Douglas G Adler, Ali A Siddiqui
No abstract text is available yet for this article.
July 2016: Endoscopic Ultrasound
Amol Bapaye, Nachiket A Dubale, Keyur A Sheth, Jay Bapaye, Jayapal Ramesh, Harshal Gadhikar, Sheetal Mahajani, Suhas Date, Rajendra Pujari, Ravindra Gaadhe
BACKGROUND AND AIM: Endoscopic ultrasonography (EUS)-guided drainage of walled-off necrosis (WON) may be carried out by placement of multiple plastic stents (MPS) or specially designed fully covered bi-flanged metal stents (BFMS). Comparative data on efficacy of these two stent types for WON drainage are limited. This retrospective study compares outcomes of WON drainage using BFMS and MPS. METHODS: During a 10-year period, 133 patients underwent EUS-guided WON drainage...
July 27, 2016: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
B Joseph Elmunzer, Gregory A Coté
No abstract text is available yet for this article.
July 15, 2016: Gastrointestinal Endoscopy
Michael Larsen, Richard A Kozarek
A disconnected pancreatic duct most commonly follows an episode of severe pancreatitis and walled-off necrosis (WON). When the latter is drained percutaneously, a pancreatic fistula connected to an upstream and disconnected duct is commonly seen. Transgastric drainage of WON with or without concomitant percutaneous drainage (dual drainage) will allow placement of two pigtail stents to drain the upstream duct and ultimately allows removal of percutaneous tubes and avoids the need for distal pancreatectomy. These stents should be left in place indefinitely...
September 2016: Current Treatment Options in Gastroenterology
Guido Costamagna
New technological developments in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, both for diagnosis and treatment of biliary and pancreatic diseases, have opened up new scenarios in the recent years. For instance, removal of large bile duct stones with endoscopic sphincterotomy followed by large balloon dilation has been proven to be a safe and effective technique. Also cholangioscopy evolved in terms of better imaging, tissue acquisition and stones management. Self-expandable metal stents are used mostly for malignant diseases, but their role in benign diseases has also been deeply investigated in the last years...
June 2016: Recenti Progressi in Medicina
Peter J Fagenholz, Ashraf Thabet, Peter R Mueller, David G Forcione
Enteric fistula is a serious complication of necrotizing pancreatitis. Endoscopic transluminal drainage and necrosectomy can significantly reduce the incidence of enterocutaneous fistula after pancreatic debridement. However, endoscopic necrosectomy may not be well-suited to debridement of necrosis that tracks laterally to the paracolic gutters, which is often more efficiently addressed by video-assisted retroperitoneal debridement (VARD). We report the combined use of endoscopic transgastric drainage and VARD for treatment of a 76 year old man with severe necrotizing acute pancreatitis complicated by infected, walled-off pancreatic necrosis...
September 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
T Kobayashi, K Miura, H Ishikawa, D Soma, Z Zhang, K Yuza, Y Hirose, K Takizawa, M Nagahashi, J Sakata, H Kameyama, S Kosugi, T Wakai
Endoscopic management of acute necrotic pancreatitis and walled off necrosis is less invasive than surgical treatment and has become the 1st choice for treating pancreatic necrosis and abscess. We treated a case of acute necrotic pancreatitis and walled off necrosis after auxiliary partial orthotopic living-donor liver transplantation (APOLT). A 24-year-old woman was admitted to our university hospital for removal of the internal biliary stent, which had already been placed endoscopically for the treatment of biliary stricture after APOLT...
May 2016: Transplantation Proceedings
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