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Endoscopic treatment with transmural drainage and necrosectomy for walled-off necrosis provides favourable long-term outcomes on pancreatic function

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@article{09aaa64bf08e4d749647f0855288bb6a,
title = "Endoscopic treatment with transmural drainage and necrosectomy for walled-off necrosis provides favourable long-term outcomes on pancreatic function",
abstract = "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.",
keywords = "Endoscopic necrosectomy, long-term follow-up, necrotising pancreatitis",
author = "Andreas Bartholdy and Mikkel Werge and Srdan Novovic and Amer Hadi and Camilla N{\o}jgaard and Anders Borch and Erik Feldager and Gluud, {Lise Lotte} and Schmidt, {Palle Nordblad}",
year = "2020",
month = "6",
doi = "10.1177/2050640620916029",
language = "English",
volume = "8",
pages = "552--558",
journal = "United European Gastroenterology Journal",
issn = "2050-6414",
publisher = "SAGE Journals",
number = "5",

}

RIS

TY - JOUR

T1 - Endoscopic treatment with transmural drainage and necrosectomy for walled-off necrosis provides favourable long-term outcomes on pancreatic function

AU - Bartholdy, Andreas

AU - Werge, Mikkel

AU - Novovic, Srdan

AU - Hadi, Amer

AU - Nøjgaard, Camilla

AU - Borch, Anders

AU - Feldager, Erik

AU - Gluud, Lise Lotte

AU - Schmidt, Palle Nordblad

PY - 2020/6

Y1 - 2020/6

N2 - 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.

AB - 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.

KW - Endoscopic necrosectomy

KW - long-term follow-up

KW - necrotising pancreatitis

UR - http://www.scopus.com/inward/record.url?scp=85084066688&partnerID=8YFLogxK

U2 - 10.1177/2050640620916029

DO - 10.1177/2050640620916029

M3 - Journal article

VL - 8

SP - 552

EP - 558

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

SN - 2050-6414

IS - 5

ER -

ID: 59741897