Structured approach to endoscopic necrosectomy improves efficiency with fewer sessions

A predefined, structured, stepwise approach to endoscopic necrosectomy has been shown to enhance efficiency of the procedure by reducing the number of necrosectomy sessions, reports a recent study.

There has been no consensus on the optimal approach to performing direct endoscopic necrosectomy (DEN), a labour-intensive, nonstandardized intervention, despite the growing number of procedures being carried out, according to the authors. To address this, they prospectively validated the utility of a structured, stepwise approach to DEN with the aim of improving procedural efficiency and resource use.

Patients with necrotizing pancreatitis who did not show clinical improvement and required DEN after endoscopic transluminal drainage were included in this study, which was undertaken in two phases.

In phase I, a retrospective analysis of interventions was conducted using an unstructured, conventional approach. Two to three sessions of necrosectomy were needed to achieve 80-percent treatment success in 20 patients. Based on these observations, the authors developed and prospectively validated a structured approach that included three steps (debridement, necrosis extraction, and irrigation) in phase II, which included 39 patients.

No significant difference in treatment success was observed (phase I vs II: 80.0 percent vs 94.9 percent; p=0.17), but the procedure was more efficient in the second phase (median session, 2 vs 3; p=0.003).

In multiple logistic regression analysis, a structured, stepwise approach resulted in fewer necrosectomy sessions to achieve treatment success (odds ratio, 4.7, 95 percent confidence interval, 1.5–15.0; p=0.008) when adjusted for patient demographics, lab parameters, and disease characteristics.