Late-stage complications of acute pancreatitis: Encapsulated necrosis of the pancreas
Conditions
Interventions
LAMS Group:EUS-guided puncture through gastric or duodenal wall into necrotic cavity with placement of LAMS (20mm length, 16mm diameter), with endoscopic debridement of necrotic tissue as needed
if suspected pancreatic duct interruption syndrome, switch to plastic stent according to protocol
DPPS Group:EUS-guided puncture through gastric or duodenal wall into necrotic cavity with placement of double-pigtail plastic stent (DPPS), with endoscopic debridement of necrotic tissue as needed
if suspected pancreatic duct interruption syndrome, leave stent in place indefinitely according to protocol
Sponsors
The first affiliated hostipal of nanchang university
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Inclusion criteria
Inclusion criteria: 1. Aged 18–80 years, no sex restriction; 2. CT or MRI shows WON adjacent to the gastric or duodenal wall; 3. Maximum cross-sectional diameter of the lesion >=6 cm; 4. Presence of at least one of the following symptoms: (1) Obvious compressive symptoms, including abdominal pain, abdominal distension, vomiting, jaundice, etc.; (2) Persistent fever with clinically suspected or confirmed infected walled-off necrosis (confirmed by positive culture of drainage fluid, presence of air bubbles within WON suggestive of infection, or persistent sepsis with no other identifiable cause of infection); (3) Rapid enlargement of the lesion in a short period; 5. Proportion of necrotic debris within the walled-off necrosis >30%; 6. Signed informed consent.
Exclusion criteria
Exclusion criteria: 1. Coagulation dysfunction (INR > 1.5), thrombocytopenia ( 2 cm); 6. Severe cardiopulmonary disease or other conditions precluding tolerance of the procedure; 7. Pregnant or lactating patients; 8. Previous endoscopic drainage or debridement for WON, or percutaneous drainage performed during the current hospitalization; 9. Imaging findings indicate extensive extension of WON toward the paracolic sulcus and retroperitoneum in the pelvic direction, where endoscopic drainage alone may not achieve adequate debridement; 10. Patients who refuse to sign the informed consent form.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of endoscopic debridements after stent drainage in the two groups.; | — |
Secondary
| Measure | Time frame |
|---|---|
| Conversion to surgery, mortality, postoperative hospital stay (from the time of puncture drainage to discharge), proportion of patients admitted to the intensive care unit (ICU) after drainage, total;Complications related to operation or stent;Technical success rate;Duration of EUS drainage procedure;Total number of additional interventions required;Clinical success rate; | — |
Countries
China
Contacts
Public ContactZhu Yin
The first affiliated hostipal of nanchang university
Outcome results
None listed