Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-05

AUTHORS

Sandra van Brunschot, Paul Fockens, Olaf J. Bakker, Marc G. Besselink, Rogier P. Voermans, Jan-Werner Poley, Hein G. Gooszen, Marco Bruno, Hjalmar C. van Santvoort

ABSTRACT

OBJECTIVE: We performed a systematic review to assess the outcome of endoscopic transluminal necrosectomy in necrotising pancreatitis with additional focus on indication, disease severity, and methodological quality of studies. DESIGN: We searched the literature published between January 2005 and June 2013. Cohorts, including patients with (infected) necrotising pancreatitis, undergoing endoscopic necrosectomy were included. Indication, disease severity, and methodological quality were described. The main outcomes were mortality, major complications, number of endoscopic sessions, and definitive successful treatment with endoscopic necrosectomy alone. RESULTS: After screening 581 papers, 14 studies, including 455 patients, fulfilled the eligibility criteria. All included studies were retrospective analyses except for one randomized, controlled trial. Overall methodological quality was moderate to low (mean 5, range 2-9). Less than 50 % of studies reported on pre-procedural severity of disease: mean APACHE-II score before intervention was 8; organ failure was present in 23 % of patients; and infected necrosis in 57 % of patients. On average, four (range 1-23) endoscopic interventions were performed per patient. With endoscopic necrosectomy alone, definitive successful treatment was achieved in 81 % of patients. Mortality was 6 % (28/460 patients) and complications occurred in 36 % of patients. Bleeding was the most common complication. CONCLUSIONS: Endoscopic transluminal necrosectomy is an effective treatment for the majority of patients with necrotising pancreatitis with acceptable mortality and complication rates. It should be noted that methodological quality of the available studies is limited and that the combined patient population of endoscopically treated patients is only moderately ill. More... »

PAGES

1425-1438

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-013-3382-9

DOI

http://dx.doi.org/10.1007/s00464-013-3382-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1016540495

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24399524


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