Endoscopic necrosectomy is a medical procedure used to remove dead or infected tissue from the pancreas or surrounding areas. It involves using an endoscope, a flexible tube with a camera, to access and clear out the affected tissue. This minimally invasive technique addresses complications arising from severe inflammation of the pancreas.
Understanding Pancreatic Necrosis
Pancreatic necrosis is a serious complication that can occur following severe acute pancreatitis, where the pancreas becomes inflamed. This inflammation can lead to the death of pancreatic tissue, a process known as necrosis. Common causes of acute pancreatitis include gallstone disease and excessive alcohol consumption.
When pancreatic tissue dies, it can form a collection of dead tissue and fluid that may or may not be infected. If this necrotic tissue becomes infected by bacteria or fungi, it poses a significant risk of complications, including sepsis and multi-organ failure, which can be life-threatening. Even sterile (non-infected) necrotic tissue can cause persistent symptoms like severe abdominal pain, ongoing pancreatitis symptoms, or obstruction, requiring intervention. Therefore, addressing pancreatic necrosis is a necessary step to prevent further deterioration and improve patient outcomes.
The Endoscopic Necrosectomy Procedure
The procedure begins with the patient under sedation or general anesthesia. An endoscope, a thin, flexible tube with a camera, is inserted through the mouth, guided down the esophagus, and into the stomach or duodenum.
Using endoscopic ultrasound (EUS) and live X-ray imaging, the necrotic collection is precisely located. An opening is then created in the wall of the stomach or duodenum to access the necrotic cavity. This opening is subsequently dilated to a diameter of at least 15 mm, allowing the endoscope to pass into the collection.
Once inside the cavity, the endoscopist uses various specialized tools to break up and remove the solid necrotic material, which is then pulled out or flushed into the stomach or duodenum. Irrigation with saline may also be performed to clear the cavity. Multiple sessions over several days or weeks are required to completely remove all necrotic tissue, with one or more stents or irrigation catheters may be left in place for drainage.
Advantages of the Endoscopic Approach
The endoscopic approach to necrosectomy offers several advantages over traditional open surgical methods. This minimally invasive technique avoids large external incisions by gaining internal access through the stomach or duodenum. This results in less surgical trauma and less post-procedure pain.
Patients undergoing endoscopic necrosectomy experience shorter hospital stays compared to those who have open surgery. The recovery period is quicker, allowing patients to return to their normal activities sooner. Studies have indicated that endoscopic management is associated with a lower risk of major complications when compared to surgical treatment. This technique also minimizes the risk of fluid and electrolyte loss and reduces overall treatment costs.
Patient Experience and Recovery
Following an endoscopic necrosectomy, patients can expect a period of recovery that varies. Immediately after the procedure, patients are monitored as the sedation wears off. It is common to experience temporary discomfort such as bloating, nausea, gagging, belching, or a sore throat.
Multiple procedures may be necessary, with subsequent endoscopies scheduled within one to two weeks of the initial procedure. Follow-up appointments are scheduled about two weeks post-operation, then monthly until full recovery. Patients are prescribed antibiotics to prevent infection.
During recovery, lifestyle adjustments are recommended. Patients may be advised to start with clear liquids and gradually advance to solid foods, eating small, frequent meals. Avoiding greasy, fried, and high-fat foods is suggested, and some patients may need to limit raw fruits and vegetables. Hydration is important, with recommendations to sip fluids throughout the day and avoid drinking large amounts with meals to avoid feeling overly full. Physical activity levels will be gradually increased.