Abstract
Background : Infected pancreatic necrosis (walled-off necrosis : WON) is the major risk factor for sepsis or multiple organ failure after severe acute pancreatitis. For treatment, direct endoscopic necrosectomy (DEN) has been performed as an alternative to percutaneus CT-guided drainage in our hospital.
Objective : The clinical usefulness of two treatment procedures was evaluated in 6 cases of WON. Between July 2009 and June 2011, 3 patients were treated by EUS-guided drainage and 3 patients were treated by CT-guided percutaneous drainage.
Results : Of the 6 cases of WON, 3 were managed by DEN after EUS-guided drainage. Although 1 of the 3 patients required CT-guided drainage because of an abscess extending to the posterior pararenal space, the treatment was successful in all 3 patients without any complications. The other 3 cases of WON were managed by CT-guided percutaneus drainage because their clinical conditions were unstable and they required intensive care. That treatment was successful in all 3 patients after a long hospitalization.
Conclusions : Although EUS-guided drainage is an effective initial therapy and DEN is also an efficacious technique with an acceptable safety profile, we would not primarily recommend endotherapy for unstable cases or cases with a large abscess extending far from the transluminal access point ; i.e., those in the posterior pararenal space and the pelvis. In such cases, CT-guided percutaneus drainage should be considered for initial or additional therapy.
