Aim

Endoscopic necrosectomy has become the first-line treatment option for infectious necrotizing pancreatitis (INP), especially walled-off necrosis. However, the problems, including operation-related adverse events (AEs) and the need for multiple endoscopic procedures, have not been effectively addressed. We sought to evaluate the clinical safety and efficacy of anhydrous ethanol-assisted endoscopic ultrasound (EUS)-guided transluminal necrosectomy in INP.

Methods

A single-center observational cohort study of INP patients was conducted in a tertiary endoscopic center. Anhydrous ethanol-assisted EUS-guided transluminal necrosectomy (modified group) and conventional endoscopic necrosectomy (conventional group) were retrospectively compared in INP patients. The technical and clinical success rates, operation time, perioperative AEs, postoperative hospital stay, and recurrent INP rates were analyzed, respectively.

Results

A total of 55 patients were enrolled. No statistically significant differences were observed between the two groups regarding baseline characteristics. Compared to patients in the conventional group, patients in the modified group demonstrated significantly reduced times of endoscopic transluminal necrosectomies (1.96 ± 0.89 vs. 2.73 ± 0.98; P = 0.004) and comparable perioperative AEs (P = 0.35). Meanwhile, no statistically significant differences were observed in the technical and clinical success rates (P = 0.92), operation time (P = 0.59), postoperative hospital stay (P = 0.36), and recurrent INP rates (P = 1.00) between the two groups.

Conclusion

Anhydrous ethanol-assisted EUS-guided transluminal necrosectomy seemed safe and effective in treating INP. Compared with conventional endoscopic transluminal necrosectomy, its advantage was mainly in reducing the number of endoscopic necrosectomies without increasing perioperative AEs.

中文翻译：

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无水乙醇辅助内镜超声引导下腔内坏死切除术治疗感染性坏死性胰腺炎的疗效和安全性

目的

内镜坏死切除术已成为感染性坏死性胰腺炎（INP），尤其是围壁性坏死的一线治疗选择。然而，包括手术相关不良事件（AE）和需要多次内窥镜手术在内的问题尚未得到有效解决。我们试图评估无水乙醇辅助内镜超声 (EUS) 引导下腔内坏死切除术治疗 INP 的临床安全性和有效性。

方法

在三级内窥镜中心对 INP 患者进行了单中心观察性队列研究。回顾性比较无水乙醇辅助EUS引导下腔内坏死组织切除术（改良组）和传统内镜下坏死组织切除术（常规组）在INP患者中的治疗效果。分别分析技术和临床成功率、手术时间、围手术期AE、术后住院时间和复发INP率。

结果

共有 55 名患者入组。两组之间的基线特征没有观察到统计学上的显着差异。与传统组患者相比，改良组患者的内镜下腔内坏死切除术次数显着减少（1.96 ± 0.89 vs. 2.73 ± 0.98；P  = 0.004），围手术期 AE 也显着减少（P  = 0.35）。同时， 两者在技术和临床成功率（ P  =0.92）、手术时间（P  =0.59）、术后住院时间（P  =0.36）和复发INP率（P =1.00）方面差异均无统计学意义。组。

结论

无水乙醇辅助超声内镜引导下腔内坏死切除术似乎安全有效地治疗 INP。与传统内镜下坏死组织切除术相比，其优势主要在于减少内镜下坏死组织切除次数，且不增加围术期AE。