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A Journal on Surgery
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,877
Minerva Chirurgica 2016 August;71(4):262-9
Pancreatic necrosectomy: an evidence-based systematic review of the levels of evidence and a comparison of endoscopic versus non-endoscopic techniques
Carmelo LUIGIANO 1, Rinaldo PELLICANO 2, Pietro FUSAROLI 3, Giuseppe IABICHINO 1, Monica ARENA 1, Andrea LISOTTI 3, Pierluigi CONSOLO 4, Carmela MORACE 4, Enrico OPOCHER 5, Giancarlo CALETTI 3, Sharmila FAGOONEE 6, Vincenzo CENNAMO 7, Carlo FABBRI 7 ✉
1 Unit of Digestive Endoscopy, San Paolo Hospital, Milan, Italy; 2 Department of Gastro-Hepatology, Città della Salute e della Scienza, Turin, Italy; 3 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S. Maria della Scaletta Hospital, Imola, Italy; 4 Department of Medicine and Pharmacology, University of Messina, G. Martino Hospital, Messina, Italy; 5 Unit of Hepatic, Biliary, Pancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy; 6 Molecular Biotechnology Center, Institute for Biostructures and Bioimaging, Consiglio Nazionale delle Ricerche (CNR), University of Turin, Turin, Italy; 7 Unit of Gastroenterology and Digestive Endoscopy, Bellaria and Maggiore Hospitals, Bologna, Italy
INTRODUCTION: Endoscopic necrosectomy is now becoming common worldwide as a minimally-invasive treatment alternative to surgical necrosectomy. The aims of this systematic review are to record the entire body of the literature accumulated over the past 15 years on endoscopic necrosectomy techniques and to compare the outcomes of endoscopic versus non-endoscopic techniques.
EVIDENCE ACQUISITION: All relevant articles were extracted up to December 2015 based on the results of searches in PubMed, Scopus and Google Scholar.
EVIDENCE SYNTHESIS: A total of 46 pertinent articles were finally included for the purpose of this systematic review. Most of the studies in our review included small numbers of patients, were retrospective and had low/moderate overall levels of evidence. The mean technical and clinical success rates reported were 99% and 89%, respectively, the mean overall complication rate was 22% and the mean overall mortality rate was 5%. The most common complications were bleeding, which occurred in 11% of patients, perforations/pneumoperitoneum which occurred in 3%, and air embolism in 0.4% of patients. The access to the cavity was created by direct endoscopic puncture in 205 patients, while endoscopic ultrasound guidance was used in 733, with no difference in technical success (99% vs. 99%), clinical success (87% vs. 89%), complications (32% vs. 21%) and mortality (7% vs. 5%) rates. Compared to the percutaneous and surgical therapies, the endoscopic techniques exhibited higher success rates and lower morbidity and mortality rates.
CONCLUSIONS: Endoscopic necrosectomy is becoming the standard of care for the treatment of pancreatic necrotic collections.