Feasibility and Safety of Endoscopic Vacuum Therapy of Walled-Off Necrosis in Acute Necrotizing Pancreatitis

Background Endoscopic vacuum therapy (EVT) is a minimal-invasive therapy for managing transmural gastrointestinal defects and supports the control of local infection. The role of EVT in patients with infected Walled-Off Necrosis (WON) resulting from acute necrotizing pancreatitis (ANP) has not yet been investigated. Methods A multicenter retrospective case analysis was conducted. Patients with infected WON due to severe ANP (Revised Atlanta Classification), in whom the standard step-up therapy was expanded to include EVT, were identified and included in the study. Results Sixteen patients (aged 22-81 years) were treated in addition to standard therapy with EVT in 4 tertiary care centers in Germany and Brazil. After a total of 108 EVT device exchanges, the clinical success (sepsis control, complete resolution of WON, and closure of fistula) was achieved in 14 out of 16 patients. Two patients died as a direct result of ANP and WON, while one further patient died of pneumosepsis after complete resolution of WON. Intracavitary bleeding occurred during device-exchange in two patients (per-procedure bleeding rate of 1.9%). Conclusions Intracavitary EVT is feasible and relatively safe in treating patients with WON. Larger prospective trials are necessary to evaluate a potential adjunctive benefit of EVT in this challenging patient cohort.