Dados do Trabalho

Título

ENDOSCOPIC PERCUTANEOUS PANCREATIC NECROSECTOMY: AN INTERVENTIONAL RADIOLOGY APPROACH

Descrição sucinta do(s) objetivo(s)

Percutaneous endoscopic pancreatic necrosectomy (PEPN) is a hybrid technique that combines endotherapy with minimally invasive percutaneous access methods. It is used for the management of severe acute necrotizing pancreatitis, avoiding the need for emergency surgery in critically ill patients. This technique is considered a viable option when percutaneous drainage catheters are insufficient and the transgastric endoscopic approach is not feasible.
In this procedure, the interventional radiologist creates a percutaneous channel that allows endoscopic access for lavage and necrosectomy. This step-up approach is crucial for managing encapsulated necrosis, as it enables a staged and less invasive intervention.
The objective of this study is to describe the experience and outcomes of patients with severe acute pancreatitis who underwent PEPN between 2020 and 2024 at our center.

Material(is) e método(s)

An observational study was conducted, selecting patients diagnosed with severe acute pancreatitis who were hospitalized and underwent PEPN between 2020 and 2024. Demographic data, technical details of the procedure, complications, and mortality rates were collected. The data were subsequently tabulated and analyzed using descriptive statistical methods. Fluoroscopic images of the procedure and corresponding CT scans were obtained by the interventional radiology team.

Resultados e discussão

A total of 15 patients (M:12, F:3) underwent PEPN. Of these, 9 survived, while 4 died after exploratory laparotomy and 2 due to multiorgan failure.
The average number of PEPN procedures per patient was 4, with a minimum of 2 and a maximum of 10. Regarding stent placement-related complications, all patients reported pain, and one case of active bleeding occurred after endoscopic lavage, which was managed by the interventional radiology team.
This case series demonstrates that PEPN is a safe technique with a low complication rate. Considering that patients with severe pancreatitis typically require frequent surgical lavages and have a high mortality rate, this study shows that the majority of patients (62.5%) who underwent PEPN did not require subsequent surgical intervention, and all of them survived hospitalization.

Conclusões

This study suggests that PEPN is a safe and effective technique for the treatment of severe acute pancreatitis, potentially reducing the need for surgical intervention and decreasing mortality rates.

Palavras Chave

Pancreatic Diseases; Percutaneous; Interventional Radiology

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