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Keywords = necrosectomy

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11 pages, 936 KiB  
Article
Endoscopic Ultrasound-Guided Drainage for Post-Pancreatitis and Post-Surgical Peripancreatic Collections: A Retrospective Evaluation of Outcomes and Predictors of Success
by Nadica Shumka and Petko Ivanov Karagyozov
Gastroenterol. Insights 2025, 16(3), 27; https://doi.org/10.3390/gastroent16030027 - 1 Aug 2025
Viewed by 180
Abstract
Background: Peripancreatic collections (PPCs) are a frequent and severe complication of acute and chronic pancreatitis, as well as pancreatic surgery, often requiring interventions to treat and prevent infection, gastric obstruction, and other complications. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive [...] Read more.
Background: Peripancreatic collections (PPCs) are a frequent and severe complication of acute and chronic pancreatitis, as well as pancreatic surgery, often requiring interventions to treat and prevent infection, gastric obstruction, and other complications. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to surgical and percutaneous approaches, offering reduced morbidity and shorter recovery times. However, the effectiveness of EUS-guided drainage in post-surgical PPCs remains underexplored. Methods: This retrospective, single-center study evaluated the technical and clinical outcomes of EUS-guided drainage in patients with PPCs between October 2021 and December 2024. Patients were categorized as having post-pancreatitis or post-surgical PPCs. Technical success, clinical success, complications, recurrence rates, and the need for reintervention were assessed. Results: A total of 50 patients underwent EUS-guided drainage, including 42 (84%) with post-pancreatitis PPCs and 8 (16%) with post-surgical PPCs. The overall technical success rate was 100%, with clinical success achieved in 96% of cases. Lumen-apposing metal stents (LAMSs) were used in 84% of patients, including 7.1% as a dual-gate salvage strategy after the failure of double-pigtail drainage. The complication rate was 24%, with infection being the most common (16%). The recurrence rate was 25%, with no significant difference between post-pancreatitis and post-surgical cases. Patients with walled-off necrosis had a significantly higher reintervention rate (35%) than those with pseudocysts (18%; p = 0.042). Conclusions: EUS-guided drainage is a highly effective and safe intervention for PPCs, including complex post-surgical cases. The 100% technical success rate reinforces its reliability, even in anatomically altered post-surgical collections. While recurrence rates remain a consideration, EUS-guided drainage offers a minimally invasive alternative to surgery, with comparable outcomes in both post-pancreatitis and post-surgical patients. Future multi-center studies should focus on optimizing treatment strategies and reducing recurrence in high-risk populations. Full article
(This article belongs to the Section Pancreas)
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10 pages, 217 KiB  
Article
Systemic Effects of Enzymatic Necrosectomy in Minor Burn Wounds Using NexoBrid®
by David Breidung, Moritz Billner, Felix Ortner, Philipp von Imhoff, Simonas Lapinskas, Konrad Karcz, Sarina Delavari and Denis Ehrl
J. Pers. Med. 2025, 15(8), 330; https://doi.org/10.3390/jpm15080330 - 25 Jul 2025
Viewed by 247
Abstract
Background/Objectives: Enzymatic debridement with NexoBrid® is an effective alternative to surgical debridement in burn care, but its potential systemic effects remain unclear. In the context of personalized burn care, understanding individual patient responses to topical agents is essential to optimize outcomes and [...] Read more.
Background/Objectives: Enzymatic debridement with NexoBrid® is an effective alternative to surgical debridement in burn care, but its potential systemic effects remain unclear. In the context of personalized burn care, understanding individual patient responses to topical agents is essential to optimize outcomes and minimize risks. This study aimed to characterize laboratory and clinical parameter changes following NexoBrid® application in patients with small burn injuries (≤10% TBSA). Methods: We retrospectively analyzed 75 burn patients treated with NexoBrid® to evaluate changes in systemic inflammatory markers, coagulation parameters, and clinical parameters before and after enzymatic debridement. Results: Statistically significant increases in body temperature (p = 0.018), decreases in hemoglobin (p < 0.001), and increases in C-reactive protein (CRP) levels (p < 0.001) were observed, suggesting mild systemic inflammatory changes. However, leukocyte counts did not change significantly (p = 0.927), and body temperature remained within the normothermic range, indicating that these changes were not clinically significant. A significant decrease in the prothrombin time ratio (% of normal; p = 0.002) was also observed, suggesting potential impacts on coagulation. Importantly, while body temperature was slightly higher in patients with a higher degree of BSA exposure within the ≤10% TBSA cohort (p = 0.036), the extent of NexoBrid® application did not correlate with other inflammatory markers. Conclusions: These findings suggest that measurable systemic changes can occur following NexoBrid® application in small burns, particularly affecting inflammatory and coagulation parameters. These observations contribute to the understanding of treatment-related responses and may help inform clinical decision-making. Full article
(This article belongs to the Special Issue Plastic Surgery: New Perspectives and Innovative Techniques)
14 pages, 1030 KiB  
Article
Lumen-Apposing Metal Stents for Endoscopic Transgastric Drainage of Pancreatic Fluid Collections in Children—A Case Report and Review of Safety and Efficacy
by Irene Wen Hui Tu, Zong Jie Koh, Khek Yu Ho, Sivaramakrishnan Venkatesh Karthik and Vidyadhar Padmakar Mali
Children 2025, 12(8), 965; https://doi.org/10.3390/children12080965 (registering DOI) - 23 Jul 2025
Viewed by 187
Abstract
Background/Objectives: Pancreatic fluid collections (PFCs) in acute pancreatitis require drainage when symptomatic or infected. Walled-off necrosis (WON) is difficult to drain with plastic stents alone. A lumen-apposing metal stent (LAMS) offers larger calibre drainage, lower migration risk than conventional methods, and the option [...] Read more.
Background/Objectives: Pancreatic fluid collections (PFCs) in acute pancreatitis require drainage when symptomatic or infected. Walled-off necrosis (WON) is difficult to drain with plastic stents alone. A lumen-apposing metal stent (LAMS) offers larger calibre drainage, lower migration risk than conventional methods, and the option of direct endoscopic necrosectomy through the stent. However, the paediatric literature on LAMSs is sparse. We report our institutional experience, and summarise current evidence on the feasibility, efficacy and safety of LAMSs for PFC drainage in children. Methods: We performed a retrospective study at the National University Hospital (NUH) and a full review of the literature on LAMS use in children for endoscopic trans-gastric drainage of PFCs from April 2012 to September 2024. Results: There were, respectively, 2 (males, 10 and 17 years) and 18 children who underwent endoscopic trans-gastric LAMS insertion for drainage of PFCs in acute pancreatitis in the NUH and across the nine included studies, which were published between 2015 and 2024. The technical and clinical success was 100%. There were no complications during insertion or indwell time (28 and 50 days in the NUH and 40 days, range of 7–100 days in the systematic review, respectively). Endoscopic removal of LAMSs was uneventful. There were no recurrent PFCs over a 4-month (1,7 months) and 12-month (range, 2–44 months) follow-up, respectively. Migration of LAMSs to colon following the collapse of the WON was reported in one case. Conclusions: An transgastric LAMS (with trans-stent necrosectomy) is a technically feasible method of drainage of WON following acute pancreatitis in children with minimal complications. Full article
(This article belongs to the Section Pediatric Surgery)
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30 pages, 692 KiB  
Review
Acute Necrotizing Pancreatitis—Advances and Challenges in Management for Optimal Clinical Outcomes
by Ioana Dumitrascu, Narcis Octavian Zarnescu, Eugenia Claudia Zarnescu, Mihai Radu Pahomeanu, Alexandru Constantinescu, Dana Galieta Minca and Radu Virgil Costea
Medicina 2025, 61(7), 1186; https://doi.org/10.3390/medicina61071186 - 30 Jun 2025
Viewed by 807
Abstract
Acute necrotizing pancreatitis (ANP), characterized by necrosis of pancreatic and/or peripancreatic tissues, is a potentially severe and life-threatening complication of acute pancreatitis, exhibiting a considerable mortality rate, particularly in the presence of infection, with rates ascending to 20–30%. Contrast-enhanced computed tomography is the [...] Read more.
Acute necrotizing pancreatitis (ANP), characterized by necrosis of pancreatic and/or peripancreatic tissues, is a potentially severe and life-threatening complication of acute pancreatitis, exhibiting a considerable mortality rate, particularly in the presence of infection, with rates ascending to 20–30%. Contrast-enhanced computed tomography is the definitive diagnostic standard, although treatment is determined by illness severity and the presence of secondary infection. The management of this condition has undergone considerable evolution, transitioning from initial surgical intervention to a more progressive, minimally invasive strategy. Initial management emphasizes aggressive fluid resuscitation, nutritional support, and monitoring of organ dysfunction. Infected necrosis is a critical factor influencing prognosis and requires intervention, typically starting with percutaneous drainage or endoscopic necrosectomy prior to evaluating surgical debridement. Recent advancements, such as the implementation of endoscopic and minimally invasive techniques, have enhanced outcomes by decreasing morbidity and mortality linked to open surgery. Despite these advancements, optimal treatment strategies are patient-specific and necessitate a multidisciplinary approach. Additional research is necessary to enhance guidelines and optimize patient outcomes. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Acute Pancreatitis)
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13 pages, 1102 KiB  
Review
The Multidisciplinary Approach to Acute Necrotizing Pancreatitis
by Dana Ben-Ami Shor, Einat Ritter, Tom Borkovsky and Erwin Santo
J. Clin. Med. 2025, 14(9), 2904; https://doi.org/10.3390/jcm14092904 - 23 Apr 2025
Viewed by 1792
Abstract
Acute pancreatitis is a common gastrointestinal condition, primarily caused by gallstones and alcohol abuse, with other causes including hypertriglyceridemia, trauma, infections, etc. While most cases are mild and self-limiting, up to 20% of patients develop severe pancreatitis with pancreatic necrosis, increasing the risk [...] Read more.
Acute pancreatitis is a common gastrointestinal condition, primarily caused by gallstones and alcohol abuse, with other causes including hypertriglyceridemia, trauma, infections, etc. While most cases are mild and self-limiting, up to 20% of patients develop severe pancreatitis with pancreatic necrosis, increasing the risk of multi-organ failure and mortality. Conservative management involves fluid resuscitation, nutritional support, and antibiotics for infected peripancreatic fluid collections (PFCs). When PFCs are infected or symptoms persist, invasive interventions such as endoscopic ultrasound (EUS)-guided drainage or percutaneous drainage are recommended. Dual modalities (endoscopic and percutaneous drainage) offer better outcomes with fewer complications. Direct endoscopic necrosectomy is considered for patients who do not improve with drainage. A multidisciplinary team, including endoscopists, interventional radiologists, surgeons, and specialists, is essential for optimal management of severe necrotizing pancreatitis. Full article
(This article belongs to the Special Issue Clinical Endoscopic Management of Pancreaticobiliary Diseases)
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10 pages, 513 KiB  
Article
Risk Factors Influencing Mortality in Open Necrosectomy for Acute Pancreatitis: A Comparative Analysis
by Tudorel Mihoc, Catalin Pirvu, Amadeus Dobrescu, Dan Brebu, Anca Monica Oprescu Macovei, Zoran Laurentiu Popa and Stelian Pantea
J. Clin. Med. 2024, 13(23), 7151; https://doi.org/10.3390/jcm13237151 - 26 Nov 2024
Viewed by 919
Abstract
Background and Objectives: Patients undergoing open necrosectomy (ON) for acute pancreatitis (AP) often face high morbidity and mortality rates. This study aims to identify risk factors associated with adverse outcomes by comparing survivors and non-survivors of ON. Materials and Methods: A [...] Read more.
Background and Objectives: Patients undergoing open necrosectomy (ON) for acute pancreatitis (AP) often face high morbidity and mortality rates. This study aims to identify risk factors associated with adverse outcomes by comparing survivors and non-survivors of ON. Materials and Methods: A retrospective analysis was conducted on 74 patients who underwent ON for AP. Patients were divided into two groups: survivors (n = 52) and non-survivors (n = 22). Preoperative and postoperative variables were compared, and p-values were calculated to identify significant differences. Results: The mortality rate was 29.73%. Significant risk factors for mortality included age over 60 (p = 0.008), multiple organ failure (p = 0.001), early necrosectomy before 28 days (p = 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (p = 0.045), and postoperative complications such as bleeding (p = 0.005) and intestinal fistula (p = 0.038). Delayed ON after 28 days showed a significantly lower mortality rate (12.5%) compared to early ON (50%). Conclusions: Age, severity of AP, timing of ON, and postoperative complications significantly influence mortality rates in patients undergoing ON. Delaying surgery beyond 28 days and optimizing surgical techniques may improve patient outcomes. Full article
(This article belongs to the Section General Surgery)
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12 pages, 1472 KiB  
Article
Step-Up versus Open Approach in the Treatment of Acute Necrotizing Pancreatitis: A Case-Matched Analysis of Clinical Outcomes and Long-Term Pancreatic Sufficiency
by Goran Pavlek, Ivan Romic, Domina Kekez, Jurica Zedelj, Tomislav Bubalo, Igor Petrovic, Ognjan Deban, Tomislav Baotic, Ivan Separovic, Iva Martina Strajher, Kristina Bicanic, Ana Ettinger Pavlek, Vanja Silic, Gaja Tolic and Hrvoje Silovski
J. Clin. Med. 2024, 13(13), 3766; https://doi.org/10.3390/jcm13133766 - 27 Jun 2024
Cited by 7 | Viewed by 4304
Abstract
Background/Objectives: Acute necrotizing pancreatitis (ANP) with secondary infection of necrotic tissue is associated with a high rate of complications and mortality. The optimal approach is still debatable, but the minimally invasive modality has gained great attention in the last decade as it [...] Read more.
Background/Objectives: Acute necrotizing pancreatitis (ANP) with secondary infection of necrotic tissue is associated with a high rate of complications and mortality. The optimal approach is still debatable, but the minimally invasive modality has gained great attention in the last decade as it follows the principle of applying minimal surgical trauma to achieve a satisfying therapeutic objective. We compared clinical outcomes between the step-up approach (SUA) and open necrosectomy (ON) in the treatment of acute necrotizing pancreatitis. Methods: A prospective cohort study over the period of 2011–2021 in a university teaching hospital was performed. Results of 99 consecutive patients with ANP who required surgical/radiological intervention were collected. A case match analysis (2:1) was performed, and the final groups comprised 40 patients in the OA group and 20 patients in the SUA group. Demographic, clinicopathologic, and treatment data were reviewed. Results: Baseline characteristics and disease severity were comparable between the two groups. The patients from the SUA group had a significantly lower morbidity rate and rate of pancreatic insufficiency. Death occurred in 4 of 20 patients (20%) in the SUA group and in 11 of 40 patients (27.5%) in the ON group (risk ratio with the step-up approach, 0.72; 95% confidence interval, 0.26 to 1.99; p = 0.53). Conclusions: A minimally invasive step-up approach provides comparable outcomes to open necrosectomy in the treatment of ANP with infected pancreatic necrosis. While mortality and hospital stay were comparable between the groups, morbidity and pancreatic insufficiency were significantly lower in the SUA group. Further studies on a larger number of patients are required to define the place of SUA in the modern treatment of ANP. Full article
(This article belongs to the Special Issue Minimally Invasive Emergency Surgery)
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17 pages, 6983 KiB  
Review
Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved
by Cecilia Binda, Stefano Fabbri, Barbara Perini, Martina Boschetti, Chiara Coluccio, Paolo Giuffrida, Giulia Gibiino, Chiara Petraroli and Carlo Fabbri
Medicina 2024, 60(2), 333; https://doi.org/10.3390/medicina60020333 - 16 Feb 2024
Cited by 5 | Viewed by 4263
Abstract
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs [...] Read more.
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs is a minimally invasive step-up approach, with endosonography-guided (EUS-guided) transmural drainage and debridement as the preferred and less invasive method. Different stents are available to drain PFCs: self-expandable metal stents (SEMSs), double pigtail stents (DPPSs), or lumen-apposing metal stents (LAMSs). In particular, LAMSs are useful when direct endoscopic necrosectomy is needed, as they allow easy access to the necrotic cavity; however, the rate of adverse events is not negligible, and to date, the superiority over DPPSs is still debated. Moreover, the timing for necrosectomy, the drainage technique, and the concurrent medical management are still debated. In this review, we focus attention on indications, timing, techniques, complications, and particularly on aspects that remain under debate concerning the EUS-guided drainage of PFCs. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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18 pages, 4001 KiB  
Review
Indications, Techniques and Future Perspectives of Walled-off Necrosis Management
by Edoardo Troncone, Rosa Amendola, Fabio Gadaleta, Elena De Cristofaro, Benedetto Neri, Pasquale De Vico, Omero Alessandro Paoluzi, Giovanni Monteleone, Andrea Anderloni and Giovanna Del Vecchio Blanco
Diagnostics 2024, 14(4), 381; https://doi.org/10.3390/diagnostics14040381 - 9 Feb 2024
Cited by 2 | Viewed by 3319
Abstract
Necrotizing pancreatitis is a complex clinical condition burdened with significant morbidity and mortality. In recent years, the huge progress of interventional endoscopic ultrasound (EUS) has allowed a shift in the management of pancreatic necrotic collections from surgical/percutaneous approaches to mini-invasive endoscopic internal drainage [...] Read more.
Necrotizing pancreatitis is a complex clinical condition burdened with significant morbidity and mortality. In recent years, the huge progress of interventional endoscopic ultrasound (EUS) has allowed a shift in the management of pancreatic necrotic collections from surgical/percutaneous approaches to mini-invasive endoscopic internal drainage and debridement procedures. The development of lumen-apposing metal stents (LAMSs), devices specifically dedicated to transmural EUS interventions, further prompted the diffusion of such techniques. Several studies have reported excellent outcomes of endoscopic interventions, in terms of technical success, clinical efficacy and safety compared to surgical interventions, and thus endoscopic drainage of walled-off necrosis (WON) has become a fundamental tool for the management of such conditions. Despite these advancements, some critical unresolved issues remain. Endoscopic therapeutic approaches to WON are still heterogeneous among different centers and experts. A standardized protocol on indication, timing and technique of endoscopic necrosectomy is still lacking, and experts often adopt a strategy based on personal experience more than robust data from well-conducted studies. In this review, we will summarize the available evidence on endoscopic management of WON and will discuss some unanswered questions in this rapidly evolving field. Full article
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13 pages, 4448 KiB  
Review
The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept
by Claudio Giovanni De Angelis, Eleonora Dall’Amico, Maria Teresa Staiano, Marcantonio Gesualdo, Mauro Bruno, Silvia Gaia, Marco Sacco, Federica Fimiano, Anna Mauriello, Simone Dibitetto, Chiara Canalis, Rosa Claudia Stasio, Alessandro Caneglias, Federica Mediati and Rodolfo Rocca
Diagnostics 2023, 13(20), 3265; https://doi.org/10.3390/diagnostics13203265 - 20 Oct 2023
Cited by 4 | Viewed by 2128
Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are both crucial for the endoscopic management of biliopancreatic diseases: the combination of their diagnostic and therapeutic potential is useful in many clinical scenarios, such as indeterminate biliary stenosis, biliary stones, chronic pancreatitis and biliary [...] Read more.
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are both crucial for the endoscopic management of biliopancreatic diseases: the combination of their diagnostic and therapeutic potential is useful in many clinical scenarios, such as indeterminate biliary stenosis, biliary stones, chronic pancreatitis and biliary and pancreatic malignancies. This natural and evident convergence between EUS and ERCP, which by 2006 we were calling the “Endoscopic ultrasonography retrograde colangiopancreatography (EURCP) concept”, has become a hot topic in the last years, together with the implementation of the therapeutic possibilities of EUS (from EUS-guided necrosectomy to gastro-entero anastomoses) and with the return of ERCP to its original diagnostic purpose thanks to ancillary techniques (extraductal ultrasound (EDUS), intraductal ultrasound (IDUS), cholangiopancreatoscopy with biopsies and probe-based confocal laser endomicroscopy (pCLE)). In this literary review, we retraced the recent history of EUS and ERCP, reported examples of the clinical applicability of the EURCP concept and explored the option of performing the two procedures in only one endoscopic session, with its positive implications for the patient, the endoscopist and the health care system. In the last few years, we also evaluated the possibility of combining EUS and ERCP into a single endoscopic instrument in a single step, but certain obstacles surrounding this approach remain. Full article
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4 pages, 889 KiB  
Case Report
The Usefulness and Reliability of Coagrasper for Artery Bleeding during Endoscopic Necrosectomy
by Yuki Ito, Mitsuru Okuno, Keisuke Iwata, Masahiro Kawade, Yuhei Iwasa, Akihiko Sugiyama, Youichi Nishigaki and Eiichi Tomita
Medicina 2023, 59(10), 1861; https://doi.org/10.3390/medicina59101861 - 19 Oct 2023
Cited by 1 | Viewed by 2012
Abstract
Although endoscopic necrosectomy (EN) is a less invasive therapy for walled-off necrosis (WON), arterial bleeding can occur during EN. A 60-year-old man with infected WON underwent the EN procedure. During EN, the artery in the WON cavity was injured. As the artery was [...] Read more.
Although endoscopic necrosectomy (EN) is a less invasive therapy for walled-off necrosis (WON), arterial bleeding can occur during EN. A 60-year-old man with infected WON underwent the EN procedure. During EN, the artery in the WON cavity was injured. As the artery was directly visible, we grasped it using a Coagrasper and coagulated the bleeding point. However, the bleeding was aggravated after coagulation owing to an extension of the vessel damage. The entire vessel was grasped, and complete hemostasis was achieved. The Coagrasper is useful for managing arterial bleeding; however, it should be employed only on the basis of its characteristics and in suitable scenarios. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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12 pages, 3967 KiB  
Article
Skin Bank Establishment in Treatment of Severe Burn Injuries: Overview and Experience with Skin Allografts at the Vienna Burn Center
by Clement J. Staud, Annika Resch, Alexandra Christ, Anton Borger, Maximilian Zaussinger, Maryana Teufelsbauer, Nina Worel and Christine Radtke
J. Clin. Med. 2023, 12(14), 4717; https://doi.org/10.3390/jcm12144717 - 17 Jul 2023
Cited by 8 | Viewed by 3255
Abstract
Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible [...] Read more.
Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible for inclusion in this retrospective study. Overall, 202 donor skin grafts obtained from the in-house skin bank were applied in the Department of Plastic and Reconstructive and Aesthetic Surgery, Medical University of Vienna. Between 2017 and 2022, we analysed the results in patient treatment, the selection of skin donors, tissue procurement, tissue processing and storage of allografts, as well as the condition and morphology of the allografts before application. The average Abbreviated Burn Severity Index (ABSI) was 8.5 (range, 5–12), and the mean affected total body surface area (TBSA) was 46.1% (range, 20–80%). In total, allograft application was performed 14 times. In two cases, a total of eight allografts were removed due to local infection, accounting for 3.96% of skin grafts. Six patients survived the acute phase of treatment. Scanning electron microscope images and histology showed no signs of scaffold decomposition and intact tissue layers of the allografts. The skin banking program and the application of skin allografts at the Vienna Burn Center can be considered successful. In severe burn injuries, skin allografts provide time by serving as sufficient wound coverage after early necrosectomy. Having an in-house skin banking program at a dedicated burn centre is particularly advantageous since issues of availability and distribution can be minimized. Skin allografts provide a reliable treatment option in patients with extensive burn injuries. Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)
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8 pages, 2795 KiB  
Case Report
Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device
by Cecilia Binda, Chiara Coluccio, Antonio Vizzuso, Alessandro Sartini, Monica Sbrancia, Alessandro Cucchetti, Emanuela Giampalma, Stefano Fabbri, Giorgio Ercolani and Carlo Fabbri
Diagnostics 2023, 13(14), 2321; https://doi.org/10.3390/diagnostics13142321 - 10 Jul 2023
Cited by 4 | Viewed by 2261
Abstract
Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely [...] Read more.
Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting. Full article
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12 pages, 2611 KiB  
Article
The Use of PuraStat® in the Management of Walled-Off Pancreatic Necrosis Drained Using Lumen-Apposing Metal Stents: A Case Series
by Cecilia Binda, Alessandro Fugazza, Stefano Fabbri, Chiara Coluccio, Alessandro Repici, Ilaria Tarantino, Andrea Anderloni and Carlo Fabbri
Medicina 2023, 59(4), 750; https://doi.org/10.3390/medicina59040750 - 12 Apr 2023
Cited by 8 | Viewed by 3269
Abstract
Background and Objectives: Bleeding is one of the most feared and frequent adverse events in the case of EUS-guided drainage of WOPN using lumen-apposing metal stents (LAMSs) and of direct endoscopic necrosectomy (DEN). When it occurs, its management is still controversial. In [...] Read more.
Background and Objectives: Bleeding is one of the most feared and frequent adverse events in the case of EUS-guided drainage of WOPN using lumen-apposing metal stents (LAMSs) and of direct endoscopic necrosectomy (DEN). When it occurs, its management is still controversial. In the last few years, PuraStat, a novel hemostatic peptide gel has been introduced, expanding the toolbox of the endoscopic hemostatic agents. The aim of this case series was to evaluate the safety and efficacy of PuraStat in preventing and controlling bleeding of WOPN drainage using LAMSs. Materials and Methods: This is a multicenter, retrospective pilot study from three high-volume centers in Italy, including all consecutive patients treated with the novel hemostatic peptide gel after LAMSs placement for the drainage of symptomatic WOPN between 2019 and 2022. Results: A total of 10 patients were included. All patients underwent at least one session of DEN. Technical success of PuraStat was achieved in 100% of patients. In seven cases PuraStat was placed for post-DEN bleeding prevention, with one patient experiencing bleeding after DEN. In three cases, on the other hand, PuraStat was placed to manage active bleeding: two cases of oozing were successfully controlled with gel application, and a massive spurting from a retroperitoneal vessel required subsequent angiography. No re-bleeding occurred. No PuraStat-related adverse events were reported. Conclusions: This novel peptide gel could represent a promising hemostatic device, both in preventing and managing active bleeding after EUS-guided drainage of WON. Further prospective studies are needed to confirm its efficacy. Full article
(This article belongs to the Special Issue Digestive Endoscopy: Inside the Evidence and Outside)
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12 pages, 1540 KiB  
Article
Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis
by Tanawat Pattarapuntakul, Tummarong Charoenrit, Thanawin Wong, Nisa Netinatsunton, Bancha Ovartlarnporn, Thanapon Yaowmaneerat, Teeravut Tubtawee, Pattira Boonsri and Pimsiri Sripongpun
Medicina 2023, 59(3), 569; https://doi.org/10.3390/medicina59030569 - 14 Mar 2023
Cited by 5 | Viewed by 2444
Abstract
Background and objectives: Symptomatic walled-off pancreatic necrosis is a serious local complication of acute necrotising pancreatitis. The endoscopic step-up approach is the standard treatment for symptomatic walled-off pancreatic necrosis; however, adjunctive radiologic percutaneous drainage for this condition is controversial. This study compared the [...] Read more.
Background and objectives: Symptomatic walled-off pancreatic necrosis is a serious local complication of acute necrotising pancreatitis. The endoscopic step-up approach is the standard treatment for symptomatic walled-off pancreatic necrosis; however, adjunctive radiologic percutaneous drainage for this condition is controversial. This study compared the clinical and radiologic resolution of walled-off pancreatic necrosis achieved with the endoscopic step-up approach with or without radiology-guided percutaneous drainage. Material and Methods: This retrospective, single-centre cohort study enrolled patients with symptomatic walled-off pancreatic necrosis who underwent endoscopic transmural drainage (ETD) followed by directed endoscopic necrosectomy (DEN) with or without radiology-guided drainage. A total of 34 patients (endoscopic approach, n = 22; combined modality approach, n = 12) underwent the endoscopic step-up approach (ETD followed by DEN). Baseline characteristics, clinical success, and resolution of necrosis were compared between groups. Results: All patients achieved symptom resolution from walled-off pancreatic necrosis. The mean patient age was 58.4 years, and 21 (61.8%) were men. Following treatment with the endoscopic approach and combined modality approach, clinical success was achieved in 90.9% of patients within 11.5 days, and 66.7% of patients within 16.5 days, respectively. Both length of hospital stay (55 days vs. 71 days; p = 0.071) and time to complete radiologic resolution were shorter (93 days vs. 124 days; p = 0.23) in the endoscopic approach group. Conclusion: Both the endoscopic step-up approach and the CMD approach resulted in a favourably high clinical resolution rates in patients with symptomatic WON. However, clinical success rates seemed to be higher, and the length of hospital stay tended to be shorter in the endoscopic approach than in the CMD approach, as well as the significantly shorter necrosectomy time in each procedure was observed. Of note, these findings might be from some inherited differences in baseline characteristics of the patients between the two groups, and a randomized controlled trial with a larger sample size to verify these results is warranted. Full article
(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)
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