Endoscopic transluminal necrosectomy in the complex treatment of a patient with acute infected necrotizing pancreatitis. Clinical case

Abstract

This study presents a clinical case of acute pancreatitis treatment, which manifested as infected walled-off necrosis in a 49-year-old obese woman. Diagnosis and treatment were provided by a multidisciplinary team comprising surgeons, anesthesiologists, interventional radiologists, and endoscopists. The treatment strategy followed a «step-up approach,» a modern technique involving gradual progression from less to more invasive methods, thereby reducing the physiological stress on the patient. This approach has demonstrated efficacy in numerous studies. In Western countries, endoscopic transluminal necrosectomy is gaining popularity, and our clinic has been implementing it successfully since 2021. Despite its effectiveness, clinicians still encounter challenges when opting for endoscopic transluminal interventions over other minimally invasive methods. Key issues include determining the timing and frequency of interventions, choosing debridement techniques and antiseptics for walled-off necrosis, and establishing criteria for transitioning to more invasive procedures. Today, researchers handle these nuances on a case-by-case basis, relying on the expertise and proficiency of a specific specialized department, which necessitates further research. In this case the patient achieved complete debridement of a localized fluid/necrosis collection through a stepwise approach. Initial management involved ultrasound-guided percutaneous drainage and lavage, followed by four sessions of endoscopic transluminal necrosectomy as the final minimally invasive intervention. We assess the unfavorable long-term outcomes, 2.5 years post-treatment, as negligible.