PMID- 32477449
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 1948-5190 (Print)
IS  - 1948-5190 (Electronic)
VI  - 12
IP  - 5
DP  - 2020 May 16
TI  - Endoscopic pancreatic necrosectomy in the United States-Mexico border: A cross 
      sectional study.
PG  - 149-158
LID - 10.4253/wjge.v12.i5.149 [doi]
AB  - BACKGROUND: A recent expert panel issued recommendations about the technical 
      aspects of direct endoscopic necrosectomy (DEN) for pancreatic walled-off 
      necrosis (WON). However, significant technical heterogeneity still exists among 
      endoscopists. AIM: To report the outcomes of our DEN technique and how it differs 
      from a recent expert consensus statement and previous studies. METHODS: Medical 
      records of patients with WON who underwent DEN from September 2016 - May 2019 
      were queried for the following information: Age, gender, ethnicity, etiology of 
      acute pancreatitis, WON location and size, DEN technical information, adverse 
      events (AEs) and outcomes. Adverse events were graded according to the American 
      Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success 
      was defined as adequate lumen apposing metal stent (LAMS) deployment plus removal 
      of >/= 90% of necrosum. Clinical success was defined as complete resolution of WON 
      cavity by imaging and resolution of symptoms at </= 3 months (mo) after last DEN. 
      Data analysis was performed using mean and standard deviation for continuous 
      variables, frequency and proportion for categorical variables, and median and 
      range for interval data. RESULTS: A total of 21 patients underwent DEN. Most of 
      them were Hispanic and their mean age was 51 +/- 17 years. The majority of the 
      collections were located in the body of the pancreas and the mean size was 13 cm 
      +/- 5 cm. The most common indication was persistent vomiting. Antibiotics were 
      administered only in cases of infected necrosis. All LAMS were placed without 
      radiological guidance, dilated the same day of deployment and removed after a 
      mean of 27 +/- 11 d. Routine cross-sectional imaging immediately after drainage was 
      not performed. The mean interval between DEN sessions was 7 +/- 4 d and the mean 
      number of DEN/patient was 3 +/- 2. Technical and clinical success rates were both 
      95%. AEs were seen in 5 patients and included: Sepsis (2), stent migration (1), 
      stent maldeployment (1), perforation (1). The sensitivity and positive predictive 
      value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No 
      fatalities were observed. CONCLUSION: Our DEN technique differed significantly 
      from the one recommended by a recent expert panel and the one published in 
      previous studies. Despite these differences excellent clinical outcomes were 
      obtained.
CI  - (c)The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights 
      reserved.
FAU - Mendoza Ladd, Antonio
AU  - Mendoza Ladd A
AD  - Department of Internal Medicine, Division of Gastroenterology, Texas Tech 
      University Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX 
      79905, United States. dr_ladd25@yahoo.com.
FAU - Bashashati, Mohammad
AU  - Bashashati M
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center, 
      Paul L Foster School of Medicine, El Paso, TX 79905, United States.
FAU - Contreras, Alberto
AU  - Contreras A
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center, 
      Paul L Foster School of Medicine, El Paso, TX 79905, United States.
FAU - Umeanaeto, Onyedika
AU  - Umeanaeto O
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center, 
      Paul L Foster School of Medicine, El Paso, TX 79905, United States.
FAU - Robles, Alejandro
AU  - Robles A
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center, 
      Paul L Foster School of Medicine, El Paso, TX 79905, United States.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Gastrointest Endosc
JT  - World journal of gastrointestinal endoscopy
JID - 101532474
PMC - PMC7243577
OTO - NOTNLM
OT  - Clinical outcomes
OT  - Endoscopic necrosectomy
OT  - International consensus
OT  - Lumen-apposing metal stents
OT  - Technical differences
OT  - Walled-off necrosis
COIS- Conflict-of-interest statement: We have no financial relationships to disclose.
EDAT- 2020/06/02 06:00
MHDA- 2020/06/02 06:01
PMCR- 2020/05/16
CRDT- 2020/06/02 06:00
PHST- 2020/03/27 00:00 [received]
PHST- 2020/05/06 00:00 [revised]
PHST- 2020/05/12 00:00 [accepted]
PHST- 2020/06/02 06:00 [entrez]
PHST- 2020/06/02 06:00 [pubmed]
PHST- 2020/06/02 06:01 [medline]
PHST- 2020/05/16 00:00 [pmc-release]
AID - 10.4253/wjge.v12.i5.149 [doi]
PST - ppublish
SO  - World J Gastrointest Endosc. 2020 May 16;12(5):149-158. doi: 
      10.4253/wjge.v12.i5.149.