Pancreatic Disorders & Therapy
Open Access

Abstract

Analyzing Endoscopic Treatment for Symptomatic Pancreatic Necrotic Collection Retrospectively: The Impact of Intervention Timing

Amin R Soliman*, Azza Baz, Mohamed I Farid, Mohamed E Eraky, Mohamed Riad, Khaled Sharaf and Ahmed K El-Taher

Acute Necrotic Collection (ANC) and Walled-off Necrosis (WON) are two types of acute necrotizing pancreatitis complications that determined according to the duration of collection (>4 weeks) and a weakly formed wall. The risks and benefits of endoscopic treatment of pancreatic necrosis, which occurs approximately four weeks after the onset of illness, can be discussed in our work. In the late stage of Atrial Natriuretic Peptide (ANP), Walled-off Pancreatic Necrosis (WOPN) is typically treated by EUS-guided transmural endoscopic drainage. In the initial stages of ANP, the function of endoscopic intervention is controversial and not clear. The objective of this study was to compare endoscopic draining of early WOPN with endoscopic treatment.

Materials and methods: In total, 142 patients with ANP underwent endoscopy. Endoscopic intervention was performed within the first four weeks of ANP in 50 (35.21%) patients with ANC (Group 1) and 92 (64.79%) patients four weeks after the onset of ANP with WOPN (Group 2). We aimed to improve our conclusions about early WON therapy by matching patients with WON to early intervention cases. The primary outcome was defined as the resolution of collection after endoscopic treatment.

Results: The average age of the patients was 49.9 years (range, 22-79 years), and 59% of them were male in both groups. The mean active drainage timing for group 1 was 26.8 and 16.9 days, while for group 2, it was 270.8 and 164.2 days. The median number of endoscopic drainages in Group 2 was between 4.5 and 9.5 (p=0.0001). The long- term success rates did not differ significantly between the groups (p>0.05). The primary result of early WON timing, based on the additional subgroups, showed no deaths and similar rates of serious side effects after initial assistance, but the total period of treatment was longer (103 vs. 69 days, p=0.042) than that in the matching control group.

Conclusion: Using endoscopy, early ANCs can be successfully treated during the first four weeks of ANP. However, more procedures and a longer drainage period are needed in comparison with early endoscopic intervention in WOPN.

Published Date: 2024-07-15; Received Date: 2024-06-14