Pancreatic Necrosectomy Using Covered Esophageal Stents A Novel Approach

Background: Endoscopic necrosectomy for necrotizing pancreatitishas been increasingly used as an alternative to surgical or percu-taneous interventions. The use of fully covered esophageal self-expandable metallic stents may provide a safer and more efficientroute for internal drainage. The aim of this study was to evaluatethe safety and efficacy of endoscopic treatment of pancreaticnecrosis with these stents.Methods: A retrospective study at 2 US academic hospitalsincluded patients with infected pancreatic necrosis from July 2009to November 2012. These patients underwent transgastric place-ment of fully covered esophageal metallic stents draining thenecrosis. After necrosectomy, patients underwent regular sessionsof endoscopic irrigation and debridement of cystic contents.The efficacy endpoint was successful resolution of infected pan-creatic necrosis without the need for surgical or percutaneousinterventions.Results: Seventeen patients were included with the mean age of41±12 years. A mean of 5.3±3.4 sessions were required forcomplete drainage and the follow-up period was 237.6±165 days.Etiology included gallstone pancreatitis (6), alcohol abuse (6), s/pdistal pancreatectomy (2), postendoscopic retrograde chol-angiopancreatography pancreatitis (1), medication-induced pan-creatitis (1), and hyperlipidemia (1). Mean size of the necrosis was14.8cm (SD 5.6cm), ranging from 8 to 19cm. Two patientsfailed endoscopic intervention and required surgery. The onlycomplication was a perforation during tract dilation, which wasmanaged conservatively. Fifteen patients (88%) achieved completeresolution.Conclusions: Endoscopic necrosectomy with covered esophagealmetal stents is a safe and successful treatment option for infectedpancreatic necrosis.Key Words: pancreatic necrosectomy, stent, CSEMS, endoscopy