A radical treatment for walled‐off necrosis: Transmural naso‐cyst continuous irrigation

Abstract

Background and Aims

The treatment efficiency of walled‐off necrosis (WON) using endoscopic ultrasound‐guided drainage (EUS‐D) with a double pigtail stent (DPS) is limited. Endoscopic necrosectomy is often performed if EUS‐D fails. However, endoscopic necrosectomy is associated with significant morbidity and mortality. Thus, we developed transmural naso‐cyst continuous irrigation (TNCCI) as an alternative therapeutic option for WON. This study aimed to evaluate the usefulness of TNCCI therapy for WON.

Methods

Between April 2009 and March 2018, 18 of 39 patients admitted with WON underwent EUS‐D. Ten consecutive patients also received TNCCI therapy (TNCCI group) between May 2015 and March 2018. TNCCI was performed by inserting an external tube from the gastroduodenal lumen into the WON under endoscopic ultrasonography guidance and then continuously irrigating the WON with saline at a rate of 40 ml/hr. Nine consecutive patients who underwent EUS‐D without TNCCI therapy between April 2009 and April 2015 were used for comparison (control group). Various parameters were compared between the TNCCI and control groups.

Results

The amount of time taken to reduce WON (6 vs. 32 days, p = 0.001), the implementation rate of endoscopic necrosectomy (0% vs. 55.6%, p = 0.01), and the number of endoscopic necrosectomy sessions per patient (0 vs. 0.8 ± 1.0, p = 0.008) were significantly lower in the TNCCI group than in the control group.

Conclusions

WON can be effectively and safely treated via endoscopic drainage with a DPS and TNCCI. This technique can be an alternative therapeutic option before endoscopic necrosectomy.

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