Feasibility and Safety of Endoscopic Vacuum Therapy of Walled-Off Necrosis in Acute Necrotizing Pancreatitis.

Background Endoscopic vacuum therapy (EVT) is a minimally invasive therapy for managing transmural gastrointestinal defects and supports the control of local infection. The role of EVT in patients with infected walled-off necrosis (WON) resulting from acute necrotizing pancreatitis (ANP) has not yet been investigated. Methods A multicenter retrospective case analysis was conducted. Patients with infected WON due to severe ANP (Revised Atlanta Classification) in whom the standard step-up therapy was expanded to include EVT, were identified and included in the study. Results Sixteen patients (aged 22-81 years) were treated in addition to standard therapy with EVT in four tertiary care centers in Germany and Brazil. After a total of 108 EVT device exchanges, the clinical success (sepsis control, complete resolution of WON, and closure of fistula) was achieved in 14 of 16 patients. Two patients died as a direct result of ANP and WON, while one further patient died of pneumosepsis after complete resolution of WON. Intracavitary bleeding occurred during device exchange in two patients, corresponding to a per-procedure bleeding rate of 1.9%. Conclusions Intracavitary EVT is feasible and relatively safe in treating patients with WON. Larger prospective trials are necessary to evaluate a potential adjunctive benefit of EVT in this challenging patient cohort.