Original articleClinical endoscopyMultiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis
Section snippets
Patients
The study cohort comprised all patients with symptomatic walled-off pancreatic necrosis who underwent endoscopic transmural drainage over a 6-year period from 2004 to 2010. Indications for endoscopic drainage were the following: (1) CT-confirmed walled-off pancreatic necrosis measuring >6 cm in size and located adjacent to the stomach or duodenum, (2) evidence of ongoing infection (abdominal pain and fever) despite administration of intravenous antibiotics, (3) continued clinical deterioration
Results
Of the 60 patients who underwent endoscopic drainage of walled-off pancreatic necrosis over a 6-year period, 48 were treated by CDT and 12 by MTGT. There was no difference in patient demographics, laboratory indices, and CT severity index between both cohorts (Table 1). With the exception of lesions in 8 patients (16.6%) in the CDT cohort, all other walled-off pancreatic necrosis lesions in both groups measured more than 80 mm in diameter, a majority of which were drained via the transgastric
Discussion
This study describes a new EUS-based approach to the management of symptomatic walled-off pancreatic necrosis. In a select group of patients, the MTGT is a minimally invasive treatment option that precludes the need for surgery or endoscopic necrosectomy. Despite several recent developments, the management of walled-off pancreatic necrosis remains a challenge. To offset the morbidity and mortality associated with surgical debridement,4, 5 other minimally invasive approaches such as percutaneous
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.