Complications Requiring Abdominal Surgery in Endoscopically Treated Patients With Pancreatic Walled-off Necrosis: Single Centre Case Series

OBJECTIVE: Although surgery has a limited role in the treatment of pancreatic walled-off necrosis (WON), complications may arise during endoscopic treatment that require surgical intervention. Likewise, insufficient endoscopic debridement may necessitate surgical step-up. The aim of this study was to evaluate complications necessitating abdominal surgery in patients undergoing endoscopic treatment for symptomatic WON.

MATERIALS AND METHODS: In this retrospective study, we reviewed consecutive patients with WON treated endoscopically at a tertiary referral center during a 10-year period to identify cases who required abdominal emergency surgery.

RESULTS: A total of 271 patients with WON were included, of whom 24 (9%) developed abdominal complications requiring surgical intervention. Eight patients underwent surgery before endoscopic intervention and 16 (66%) after. The most prevalent complication was intestinal ischemia in 11 cases (46%), bleeding in 4 cases (17%), intestinal perforation in 3 cases (13%), bowel stenosis in 3 cases (13%), and fistula in 3 cases (13%). The mortality during admission did not differ significantly between patients requiring surgery and patients who did not (20.8% vs 13.8%, P = 0.392).

CONCLUSIONS: This study demonstrates that complications requiring abdominal surgery in patients undergoing endoscopic treatment for WON occur in one of 10 patients, intestinal ischemia being the most frequent cause of intervention.