Internal Medicine Resident University of Arizona College of Medicine Phoenix, AZ
Paul Muna Aguon, MD1, Layth Al-Jashaami, MD1, Aida Rezaie, MD2, Sarabdeep Mann, MD1, Shifat Ahmed, MD1, Nael Haddad, MD1, Sakolwan Suchartlikitwong, MD1, Rawad Mounzer, MD3, Teodor Pitea, MD3; 1University of Arizona College of Medicine, Phoenix, AZ; 2Banner Good Samaritan Medical Center, Mesa, AZ; 3Banner University Medical Center, Phoenix, AZ
Introduction: Percutaneous endoscopic necrosectomy (PEN) is emerging as an alternative to surgical necrosectomy for walled-off necrosis (WON) collections that are laterally displaced and may not be appropriate for the traditional endoscopic approach. It is a minimally invasive pathway that allows for patients to avoid major surgery and the risks associated with it.
Our aim is to describe our institutional protocol on how to perform successful, safe and effective PENs via a fully-covered self-expandable metallic stent (FC-SEMS) for WON collection that is not amenable to a transluminal approach.
Methods: A retrospective analysis was performed on patients with persistent WON collections and sepsis that were not amenable to transluminal approach who underwent PEN through a FC-SEMS from December 2018 to August 2019. Following deployment of the FC-SEMS through the percutaneous tract, endoscopic necrosectomies were performed until all necrotic tissue removed. After the FC-SEMS was removed, a 20-Fr catheter was placed until the output was less than 10mL per day and finally withdrawn. Empiric antibiotics were continued until the final drain was removed. A follow up CT was performed in all patients. Discussion: A total of 5 patients (mean age 45.2 years; 60% males) had undergone PEN at our institution. All patients presented with severe sepsis. Technical procedural success and clinical success was 100%. There were no complications related to the FC-SEMS placement and no reported stent migration. A fully-covered Bonastent esophageal stent was used in 100% of patients. On average, the size of the WON was 18.4cm in cross-sectional diameter. The average time from onset of symptoms to PEN was 69 days. The average number of sessions per patient was 3 with an average interval of 2.2 days. The average time from initial FC-SEMS placement to complete resolution of symptoms (removal of all drains) was 31.8 days. Complete resolution of WON collections noted in all patients. PEN is a minimally invasive procedure for WON collections that are not amenable to transluminal drainage with high technical and clinical success with our institutional protocol, utilizing FC-SEMS, such as Bonastent esophageal stents, with repeat endoscopic necrosectomy sessions every 2 days until resolution.
Disclosures: Paul Muna Aguon indicated no relevant financial relationships. Layth Al-Jashaami indicated no relevant financial relationships. Aida Rezaie indicated no relevant financial relationships. Sarabdeep Mann indicated no relevant financial relationships. Shifat Ahmed indicated no relevant financial relationships. Nael Haddad indicated no relevant financial relationships. Sakolwan Suchartlikitwong indicated no relevant financial relationships. Rawad Mounzer indicated no relevant financial relationships. Teodor Pitea indicated no relevant financial relationships.