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  • Title: Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos).
    Author: Raczynski S, Teich N, Borte G, Wittenburg H, Mössner J, Caca K.
    Journal: Gastrointest Endosc; 2006 Sep; 64(3):420-4. PubMed ID: 16923493.
    Abstract:
    BACKGROUND: Endoscopic drainage of pancreatic acute and chronic pseudocysts and pancreatic necrosectomy have been shown to be beneficial for critically ill patients, with complete endoscopic resolution rates of around 80%. OBJECTIVE: Our purpose was to describe an improved endoscopic technique used to treat pancreatic necrosis. DESIGN: Case report. SETTING: University hospital. PATIENTS AND INTERVENTIONS: Two patients with large retroperitoneal necroses were treated with percutaneous transgastric retroperitoneal flushing tubes and a percutaneous transgastric jejunal feeding tube by standard percutaneous endoscopic gastrostomy access in addition to endoscopic necrosectomy. RESULTS: Intensive percutaneous transgastric flushing in combination with percutaneous normocaloric enteral nutrition and repeated endoscopic necrosectomy led to excellent outcomes in both patients. LIMITATIONS: Small number of patients. CONCLUSIONS: The "double percutaneous endoscopic gastrostomy" approach for simultaneous transgastric drainage and normocaloric enteral nutrition in severe cases of pancreatic necroses is safe and effective. It could be a promising improvement to endoscopic transgastric treatment options in necrotizing pancreatitis.
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