Comparison Of Operative And Endoscopic Transgastric Debridement For Patients With Necrotizing Pancreatitis
*Tom K Maatman, *Sean P McGuire, *Jeffrey J Easler, *Mohammad A Al-Haddad, *Benjamin L Bick, *Eugene P Ceppa, *John M Dewitt, *Katelyn F Flick, *Evan L Fogel, *Mark A. Gromski, Michael G House, *Mackenzie G. Madison, *Atilla Nakeeb, Christian M Schmidt, *Stuart Sherman, Nicholas J Zyromski
Indiana University, Indianapolis, IN
Objectives: Select patients with anatomically favorable walled off pancreatic necrosis may be treated by operative (OR-TGD) or endoscopic (Endo-TGD) transgastric debridement. Limited data exist contrasting these two approaches.
Methods:Patients undergoing OR-TGD and Endo-TGD at a single, high-volume pancreatic center between 2008-2019 were identified from a prospective database. Patient characteristics, procedural details, and outcomes of these two groups were compared.
Results:Among 601 NP patients undergoing necrosis intervention, 160 (30%) had TGD: 101 OR-TGD and 59 Endo-TGD. The groups were statistically similar in age, comorbidity, pancreatitis etiology, necrosis anatomy, pancreatitis severity, and timing of TGD from pancreatitis insult. OR-TGD required 1.1 ± 0.5 and Endo-TGD 3.0 ± 2.0 debridements/patient. Fewer hospital readmissions and repeat necrosis interventions, and shorter total inpatient length of stay were observed in OR-TGD patients (Table 1). New onset organ failure [OR-TGD (13%); Endo-TGD (13%), P = 1.0] was similar between groups. Hospital length of stay after TGD was significantly shorter in patients undergoing OR-TGD (9.4 ± 6.1 days) compared to Endo-TGD (13.8 ± 20.8 days, P = 0.047). Mortality was 1% in OR-TGD and 7% in Endo-TGD (P = 0.04).
Conclusions:Operative and endoscopic transgastric debridement achieve necrosis resolution with different temporal and procedural profiles. Clear multidisciplinary communication is essential to determine appropriate approach to individual necrotizing pancreatitis patients.
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