Nuretdin SUNA, Nomingerel TSEVELDORJ, Diğdem ÖZER ETİK, Fatih HİLMİOĞLU

Walled-off pankreatik nekroz tedavisinde endoskopik ultrasonografi eşliğinde endoskopik nekrozektomi: Olgu sunumu

Walled-off pankreatik nekroz, akut nekrotizan pankreatitin geç aşamasında gelişen ciddi bir lokal komplikasyondur. Nekrotik içerik enfekte olduğunda, hayatı tehdit eden bir komplikasyon haline gelir. Hastaların yarısında basınç, enfeksiyon, mide çıkış ve biliyer obstrüksiyonu ile ilişkili semptomlar gelişir. Semptomatik hastalarda organize nekrotik materyalin debridmanı gerekir. Eskiden, walled-off pankreatik nekrozun standart tedavisi açık cerrahi yöntem olsa da yüksek morbidite ve mortalite ile ilişkilidir. Bu nedenle, radyolojik ve endoskopik gibi minimal invaziv yöntemlerin ortaya çıkmasıyla açık cerrahinin rolü giderek azalmıştır. Günümüzde özellikle endoskopik ultrasonografi ile birlikte endoskopik teknikler ve aksesuarlardaki gelişmeler, peripankreatik sıvı koleksiyonlarının endoskopik tedavilerinde devrim yaratmıştır. Diğer yöntemlere göre daha düşük morbidite, mortalite ve hastanede kalış süresi ile ilişkili olan endoskopik yöntemler giderek daha çok tercih edilmektedir. Bu yazıda, endoskopik ultrasonografi eşliğinde transluminal drenaj ve endoskopik nekrozektomi yapılan walled-off pankreatik nekroz olgusunu sunuyoruz.

Anahtar Kelimeler:

Walled-off pankreatik nekroz, endoskopik nekrozektomi, endoskopik ultrasonografi

Endoscopic ultrasonography guided endoscopic necrosectomy in the treatment of walled-off pancreatic necrosis: Case report

In the late stages of acute necrotizing pancreatitis, walled-off pancreatic necrosis is a serious local complication. Infection of the necrotic component of walled-off pancreatic necrosis can result in life-threatening complications. Half of the patients may develop symptoms related to pressure, infection, gastric outlet, and biliary obstruction. Moreover, organized necrotic material should be drained from symptomatic patients. In the early years, while open surgery is the standard treatment for walled-off pancreatic necrosis, it is associated with a rate of high morbidity and mortality. As a result, the use of open surgery has declined as less invasive methods, such as radiological and endoscopic procedures, have become more common. In recent years, endoscopic techniques and accessories, especially endoscopic ultrasonography, have revolutionized the endoscopic treatment of peripancreatic fluid collections. Endoscopic methods are favored over other methods because they are associated with lower morbidity, mortality, and hospital stay. In this case report, we present a patient with walled-off pancreatic necrosis who underwent endoscopic ultrasonography -guided transluminal drainage and endoscopic necrosectomy.

Keywords:

Walled-off pancreatic necrosis, endoscopic necrosectomy, endoscopic ultrasonography,

PDF

___

1. Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11.
2. Rana SS. An overview of walled-off pancreatic necrosis for clinicians. Expert Rev Gastroenterol Hepatol 2019;13:331-43.
3. Isayama H, Nakai Y, Rerknimitr R, et al. Asian consensus statements on endoscopic management of walled-off necrosis part 1: epidemiology, diagnosis, and treatment. J Gastroenterol Hepatol 2016;31:1546-54.
4. Bang JY, Arnoletti JP, Holt BA, et al. An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. Gastroenterology 2019;156:1027-40.
5. Khan MA, Kahaleh M, Khan Z, et al. Time for a changing of guard: from minimally invasive surgery to endoscopic drainage for management of pancreatic walled-off necrosis. J Clin Gastroenterol 2019;53:81-8.
6. Yasuda I, Nakashima M, Iwai T, et al. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study. Endoscopy 2013;45:627-34.
7. Freeny PC, Hauptmann E, Althaus SJ, et al. Percutaneous CT guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 1998;170:969-75.
8. van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018;391:51-8.
9. Shenvi S, Gupta R, Kang M, et al. Timing of surgical intervention in patients of infected necrotizing pancreatitis not responding to percutaneous catheter drainage. Pancreatology 2016;16:778-87.
10. Kozarek RA, Brayko CM, Harlan J, et al. Endoscopic drainage of pancreatic pseudocysts. Gastrointest Endosc 1985;31:322-7.
11. Baron TH, Thaggard WG, Morgan DE, Stanley RJ. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996;111:755-64.
12. Seifert H, Wehrmann T, Schmitt T, et al. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 2000;356:653-5.
13. Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018;50:524-46.
14. Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: Management of pancreatic necrosis. Gastroenterology 2020;158:67-75.e1.
15. Bang JY, Wilcox CM, Arnoletti JP, Varadarajulu S. Superiority o endoscopic interventions over minimally invasive surgery for infected necrotizing pancreatitis: meta-analysis of randomized trials. Dig Endosc 2020;32:298-308.