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Endoscopic Necrosectomy Tied to Better Pancreatitis Outcomes

Last Updated: March 13, 2012.

A less invasive procedure, endoscopic transgastric necrosectomy, reduces the proinflammatory response and significant complications in patients with infected necrotizing pancreatitis, compared with surgical necrosectomy, according to a study published in the March 14 issue of the Journal of the American Medical Association.

TUESDAY, March 13 (HealthDay News) -- A less invasive procedure, endoscopic transgastric necrosectomy, reduces the proinflammatory response and significant complications in patients with infected necrotizing pancreatitis, compared with surgical necrosectomy, according to a study published in the March 14 issue of the Journal of the American Medical Association.

Olaf J. Bakker, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues randomly allocated 22 patients with signs of infected necrotizing pancreatitis and an indication for intervention to endoscopic transgastric or surgical necrosectomy. Postprocedural proinflammatory response was assessed by serum interleukin 6 (IL-6) levels. The predefined composite clinical end point was major complications, including new onset multiple organ failure, intra-abdominal bleeding, enterocutaneous fistula, pancreatic fistula, or death.

Two of the patients did not undergo necrosectomy and could not be included in the analysis. In the remaining patients, the researchers found that, compared with surgical necrosectomy, endoscopic transgastric necrosectomy significantly reduced the postprocedural IL-6 levels (P = 0.004). Following endoscopic necrosectomy, the composite clinical end point occurred significantly less often (20 versus 80 percent; risk difference [RD], 0.60; P = 0.03). No new-onset multiple organ failure was caused by endoscopic necrosectomy (0 versus 50 percent; RD, 0.50; P = 0.03) and there was a significantly reduced number of pancreatic fistulas (10 versus 70 percent; RD, 0.60; P = 0.02).

"In patients with infected necrotizing pancreatitis, endoscopic necrosectomy reduced the proinflammatory response as well as the composite clinical end point compared with surgical necrosectomy," the authors write.

Several authors disclosed financial ties to pharmaceutical and medical device companies.

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