Transgastric Debridement For Necrotizing Pancreatitis Needs
Patients required fewer interventions, spent less time in the hospital and had fewer readmissions after undergoing operative rather than endoscopic transgastric debridement for necrotizing pancreatitis, according to one of the largest case series of patients treated for this condition. But the authors say their results demonstrate that both approaches have a place in the management of necrotizing pancreatitis. Instead of advocating one approach over the other, investigators called for multidisciplinary collaboration in caring for these patients, including clinicians who have experience in surgical and endoscopic treatment, as well as percutaneous treatment and medical therapy.

Some patients treated operatively later received endoscopic and percutaneous treatment, while some treated by endoscopy required subsequent operations, he noted. The study included 643 patients with pancreatic necrosis who were treated at Hospital between 2008 and 2019. In this group, 160 patients underwent transgastric debridement: 59 were treated endoscopically (37%) and 101 operatively (63%). A multidisciplinary team made the decision on whether to use endoscopy or surgery after considering the patient’s history, the disease etiology, and clinical characteristics. Patients treated endoscopically required 3.0±2.0 debridements per patient, compared with 1.1±0.5 in the surgical group. Overall, 81% of patients who had endoscopic transgastric debridement required repeat interventions, up from 7% in the surgical group. The endoscopic approach was associated with longer postoperative lengths of stay in the hospital. Patients treated endoscopically also had higher rates of readmission. Surgical transgastric debridement should be the first choice for patients with biliary necrotizing pancreatitis and suitable anatomy, while patients with alcoholic pancreatitis or hypertriglyceridemic pancreatitis may be better suited for an endoscopic approach.