Long-term outcome following successful endoscopic drainage of organized pancreatic necrosis (OPN): Skunk-poking revisited

Academic Article

Abstract

  • INTRO: Symptomatic OPN is usually managed with necrosectomy. We have recently described endoscopic drainage of OPN with good short-term results, and now report long-term follow-up of these pts. METHODS: From 5/94-12/96, 25 pts. with documented OPN, as previously defined, underwent attempted endoscopic drainage (internal pigtail catheters & nasobiliary lavage tube). All had ≥ 30% glandular necrosis by contrast enhanced computed tomography (CECT). Mean follow-up for 13 pts. who were successfully drained endoscopically and are now 20 mos. (range 11-37 mos.) from onset of first episode of acute pancreatitis are the subjects of this study. One pt. required adjuvant percutaneous drains for resolution. No patient had previous underlying pancreatic disease. Ten of 13 agreed to participate in a protocol consisting of: A) Pancreatogram at time of stent removal B) CECT C) Fasting glucose, albumin, secretin stimulation testing (SST) and E) Symptom questionnaire. Four of 10 are awaiting SST. RESULTS: 10 PTS. WITH SUCCESSFULLY DRAINED OPN AT A MEAN OF 20 MOS. DEMOGRAPHICS ETIOLOGY PANCREATOGRAM Mean age 49 yrs. Gallstones (3) Divisum (2) Disconnected duct (9) (17-77 yrs.) Idiopathic (2) ERCP (1) Chronic pancreatitis (1) M-6 F-4 EtOH (1) Lipid (1) CECT FUNCTION SYMPTOMS Atrophy (10) Overt Diabetes Mellitus (2) None (5) Collections (6) Glucose intolerance (2) tARP (2) Calcified (2) Malabsorption, ↓ albumin (1) Chronic Pain (5) * PD dilatation (1) SST Abnl (4/6) * Pancreatic duct, 1 Acute Recurrent Pancreatitis Of the 6 pts. with collections occurring after drainage, 5 were pseudocysts, 1 was reformation of a fistula tract at the site of percutaneous drainage tract. Four of the six were symptomatic and required drainage - 3 endoscopically and 1 percutaneously. CONCLUSIONS: 1) One episode of non-alcoholic acute severe necrotizing pancreatitis may cause significant glandular atrophy in addition to other radiographic changes and pain of chronic pancreatitis 2) Disconnection of the PD (PD transection) occurs in the majority and may account for recurrent PCs or fistulae as late sequelae in this population 3) Although subtle endocrine and exocrine dysfunction occur, overt clinical endocrine and exocrine insufficiency are uncommon 4) Almost 2 years after endoscopic drainage of extensive OPN, pancreatic surgery has been avoided.
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    Author List

  • Adkisson KW; Morgan DE; Baron TH
  • Volume

  • 45
  • Issue

  • 4