Difficult Endoscopic Retrieval of a Migrated Stent inside a Pseudocyst

Endoscopic ultrasound (EUS) guided pseudocyst drainage can have complications such as bleeding, perforation, infection, and stent migration. We report a case of iatrogenic migration of stent inside a large dumbbell-shaped pseudocyst managed successfully with a difficult endoscopic retrieval procedure

Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review

We performed a systematic review to assess the outcome of endoscopic transluminal necrosectomy in necrotising pancreatitis with additional focus on indication, disease severity, and methodological quality of studies. We searched the literature published between January 2005 and June 2013. Cohorts, including patients with (infected) necrotising pancreatitis, undergoing endoscopic necrosectomy were included. Indication, disease severity, and methodological quality were described. The main outcomes were mortality, major complications, number of endoscopic sessions, and definitive successful treatment with endoscopic necrosectomy alone. After screening 581 papers, 14 studies, including 455 patients, fulfilled the eligibility criteria. All included studies were retrospective analyses except for one randomized, controlled trial. Overall methodological quality was moderate to low (mean 5, range 2-9). Less than 50 % of studies reported on pre-procedural severity of disease: mean APACHE-II score before intervention was 8; organ failure was present in 23 % of patients; and infected necrosis in 57 % of patients. On average, four (range 1-23) endoscopic interventions were performed per patient. With endoscopic necrosectomy alone, definitive successful treatment was achieved in 81 % of patients. Mortality was 6 % (28/460 patients) and complications occurred in 36 % of patients. Bleeding was the most common complication. Endoscopic transluminal necrosectomy is an effective treatment for the majority of patients with necrotising pancreatitis with acceptable mortality and complication rates. It should be noted that methodological quality of the available studies is limited and that the combined patient population of endoscopically treated patients is only moderately ill

Clinical outcome of endoscopic treatment for symptomatic sterile walled-off necrosis

Background The majority of patients with symptomatic sterile walled-off necrosis (WON) can be treated conservatively. Although endoscopic transluminal drainage (ETD) is often performed in cases of persistent symptoms, post-procedural iatrogenic infection may occur. This study aimed to evaluate clinical outcomes after ETD of symptomatic sterile WON. Methods This was a retrospective, multicenter, open-label case series of 56 patients with necrotizing pancreatitis who underwent ETD for symptomatic sterile WON between July 2001 and August 2018at two tertiary referral hospitals. Primary end point was clinically relevant post-procedural iatrogenic infection, defined as need for endoscopic transluminal necrosectomy. Secondary end points included mortality, total number of interventions, hospital stay, and resolution of symptoms at 1-year follow-up. Results ETD of sterile WON was performed in 56 patients (median age 55 years, 57% male), who presented with abdominal pain (71%), gastric outlet obstruction (45%), jaundice (20%), and failure to thrive (27%). A total of 41 patients (73%) developed clinically relevant post-procedural iatrogenic infection, resulting in a median of 3 (interquartile range [IQR] 2-4) endoscopic, radiological, and/or surgical interventions. Mortality rate was 2%. Median total hospital stay was 12 days (IQR 6-17). Resolution of symptoms was reported in 40 of 46 patients (87%) for whom long-term follow-up data were available (median follow-up 13 months, IQR 6-29). Conclusions ETD of symptomatic sterile WON resulted in high clinical success. Nonetheless, the majority of patients required additional reinterventions for clinically relevant post-procedural iatrogenic infection