Revision del papel de la endoscopia en el tratamiento de las complicaciones graves de la pancreatitis aguda, especialmente de la necrosis pancreatica

1. TRATAMIENTO ENDOSCOPICO
DE PANCREATITIS GRAVE

4. TRATAMIENTO ENDOSCOPICO
DE PANCREATITIS GRAVE

5. A Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis
Hjalmar C. van Santvoort, M.D., Marc G. Besselink, M.D., Ph.D., Olaf J. Bakker,
M.D., H. Sijbrand Hofker, M.D., Marja A. Boermeester, M.D., Ph.D., Cornelis H.
Dejong, M.D., Ph.D., Harry van Goor, M.D., Ph.D., Alexander F. Schaapherder, M.D.,
Ph.D., Casper H. van Eijck, M.D., Ph.D., Thomas L. Bollen, M.D., Bert van
Ramshorst, M.D., Ph.D., Vincent B. Nieuwenhuijs, M.D., Ph.D., Robin Timmer, M.D.,
Ph.D., Johan S. Laméris, M.D., Ph.D., Philip M. Kruyt, M.D., Eric R. Manusama, M.D.,
Ph.D., Erwin van der Harst, M.D., Ph.D., George P. van der Schelling, M.D., Ph.D.,
Tom Karsten, M.D., Ph.D., Eric J. Hesselink, M.D., Ph.D., Cornelis J. van Laarhoven,
M.D., Ph.D., Camiel Rosman, M.D., Ph.D., Koop Bosscha, M.D., Ph.D., Ralph J. de
Wit, M.D., Ph.D., Alexander P. Houdijk, M.D., Ph.D., Maarten S. van Leeuwen, M.D.,
Ph.D., Erik Buskens, M.D., Ph.D., and Hein G. Gooszen, M.D., Ph.D. for the Dutch
Pancreatitis Study Group
N Engl J Med 2010; 362:1491-1502

11. Drenaje con ecoendoscopia o
endoscopia
Endoscopic Ultrasound Drainage of Pancreatic Pseudocyst: A Prospective Comparison
with Conventional Endoscopic Drainage. M. Kahaleh; V. M. Shami; M. R. Conaway;
J. Tokar; T. Rockoff; S. A. De La Rue; E. de Lange; M. Bassignani ;S. Gay; R. B. Adams;
P. Yeaton. Endoscopy 2006; 38 (4): 355-359

12. Drenaje con ecoendoscopia o
endoscopia
Endoscopic Ultrasound Drainage of Pancreatic Pseudocyst: A Prospective Comparison
with Conventional Endoscopic Drainage. M. Kahaleh; V. M. Shami; M. R. Conaway;
J. Tokar; T. Rockoff; S. A. De La Rue; E. de Lange; M. Bassignani ;S. Gay; R. B. Adams;
P. Yeaton. Endoscopy 2006; 38 (4): 355-359

13. Necrosis pancreatica infectada:
evolución
Outcome of severe acute pancreatitis: Is there a role for conservative management of
infected pancreatic necrosis?. Amarapathy Sivasankar, Devy Gounder Kannan,
Palaniappan Ravichandran, Sathyanesan Jeswanth, Tirupporur Govindasamy
Balachandar and Rajagopal Surendran. Hepatobiliary Pancreat Dis Int 2006; 5: 599-604
N:52 pt IN, 18 surgery y 6 conservative

16. Tto conservador comparable a cia
en pacientes con necrosis infectada
Endoscopic and Percutaneous Drainage of Symptomatic Walled-Off Pancreatic Necrosis Reduces Hospital Stay and
Radiographic Resources. Michael Gluck,* Andrew Ross,* Shayan Irani,* Otto Lin,* Ellen Hauptmann,‡ Justin Siegal,‡
Mehran Fotoohi,‡ Robert Crane,‡ David Robinson,‡ and Richard a. Kozarek*. Clinical Gastroenterology and Hepatology
2010,8(12):1083-88.

17. Tto conservador comparable a cia
en pacientes con necrosis infectada
Se puede evitar cirugía en el
76% de NI y el 54,5% de las NI
se pueden manejar de forma
conservadora
Primary Conservative treatment Results in Mortality comparable to surgery in PAtients with Infected Pancreatic Necrosis.
Pramod Kumar Garg,* Manik Sharma,* Kaushal Madan,* Peush Sahni,‡ Debabrata Banerjee,* and Rohit Goyal*. Clinical
Gastroenterology and Hepatology 2010;8:1089–1094

18. Tto de colecciones pancreáticas
con protesis autoexpandibles
• Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents.
Jayant P Taljera, Vanessa M. Shami, Jennifer Ku, Tanya D. Morris; Kristi ellen, M Kahaleh. Gastrointestinal
Endoscopy 2008;68(8):1199-1203.
N:18 patients ( Jan 2007-Sep 2008)
Resolución completa del 78%, respuesta 95%;Media de dias hasta resolución: 77+-80 dias
Complications:
Superinfection 5
Bleeding 5
Migración interna 1
• Temporary cystogastostomy with self-expanding metallic stents for pancreatic necrosis. S. Belle, P
Collet, S Post, G Kaehler. Endocopy 2010;42:493-95.

19. Tto de colecciones pancreáticas
con protesis plásticas
Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after
endoscopic transmural drainage . Marianna Arvanitakis, MD, Myriam Delhaye, MD, PhD, Maria
Antonietta Bali, MD, Celso Matos, MD, Viviane De Maertelaer, PhD, Olivier Le Moine, MD, PhD,
Jacques Devie`re, MD, PhD. Gastrointestinal Endoscopy 2008;68(8):1199-1203.
Recurrencia:
•5 del grupo B
• 0 del grupo A
•Ninguno del grupo no
randomizado
N: 44 pacientes, seguidos 14 meses

20. Necrosectomia: Gepard study
Tranasluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow up (the GEPARD
Study). H Seifert, M Biermer, W Schmitt et al. Gut 2009; 58:120-1266

23. Necrosectomia en necrosis
pancreatica organizada
Endoscopic transmural debridement of symptomatic organized pancreatic necrosis. Rogier P. Voermans, MD, Marie¨lle
C. Veldkamp, MD, Erik A. Rauws, MD, PhD,Marco J. Bruno, MD, PhD, Paul Fockens, MD, PhD. Gastrointestinal
Endoscopy 2007;66(5):909-916.
Complications:
Severe complications 2 pt (7%): arterial
bleeding ( cia)
perforation of cyst wall
Minor bleeding 8pt (30%)
No mortality
Outcome:
Hospital stay 5 days
Recurrence seudocysts 2 pt

24. Necrosectomia Vs drenaje en
necrosis pancreatica organizada
A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the
treatment of walled-off pancreatic necrosis. Timothy B. Gardner, MD, Prabhleen Chahal, MBBS,
Georgios I. Papachristou, MD,Santhi Swaroop Vege, MD, Bret T. Petersen, MD, Christopher J.
Gostout, MD,Mark D. Topazian, MD, Naoki Takahashi, MD, Michael G. Sarr, MD, Todd H. Baron,
MD. Gastrointestinal Endoscopy 2009;69(6):1085-1094

25. Necrosectomia Vs drenaje en
necrosis pancreatica organizada
A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the
treatment of walled-off pancreatic necrosis. Timothy B. Gardner, MD, Prabhleen Chahal, MBBS,
Georgios I. Papachristou, MD,Santhi Swaroop Vege, MD, Bret T. Petersen, MD, Christopher J.
Gostout, MD,Mark D. Topazian, MD, Naoki Takahashi, MD, Michael G. Sarr, MD, Todd H. Baron,
MD. Gastrointestinal Endoscopy 2009;69(6):1085-1094

26. Necrosectomia Vs drenaje en
necrosis pancreatica organizada
A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the
treatment of walled-off pancreatic necrosis. Timothy B. Gardner, MD, Prabhleen Chahal, MBBS,
Georgios I. Papachristou, MD,Santhi Swaroop Vege, MD, Bret T. Petersen, MD, Christopher J.
Gostout, MD,Mark D. Topazian, MD, Naoki Takahashi, MD, Michael G. Sarr, MD, Todd H. Baron,
MD. Gastrointestinal Endoscopy 2009;69(6):1085-1094

27. Pancreatitis necrotizante manejo
conservador
Necrotizing Pancreatitis Contemporary Analysis of 99 Consecutive Cases. Stanley W.
Ashley, MD, Alexander Perez, MD, Elizabeth A. Pierce, BS, David C. Brooks, MD,
Francis D. Moore, Jr., MD, Edward E. Whang, MD, Peter A. Banks, MD, and Michael
J. Zinner, MD. Annals of Surgery Vol. 234, No. 4, 572–580

28. Cirugia en la necrosis pancreatica
SURGERY IN THE TREATMENT OF ACUTE PANCREATITIS –MINIMAL ACCESS PANCREATIC
NECROSECTOMY. S. Connor1, M. G. T. Raraty1, N. Howes1, J. Evans2, P. Ghaneh1, R. Sutton1, J. P.
Neoptolemos1. Scandinavian Journal of Surgery 94: 135–142, 2005.

29. Cirugia en la necrosis pancreatica
MANAGEMENT OF ACUTE PANCREATITIS: FROM SURGERY TO INTERVENTIONAL INTENSIVE CARE
J Werner, S Feuerbach, W Uhl, M W Bu¨chler. Gut 2005;54:426–436

30. Cirugia en la necrosis pancreatica
MANAGEMENT OF ACUTE PANCREATITIS: FROM SURGERY TO INTERVENTIONAL INTENSIVE CARE
J Werner, S Feuerbach, W Uhl, M W Bu¨chler. Gut 2005;54:426–436

31. Cirugia en la necrosis pancreatica
MANAGEMENT OF ACUTE PANCREATITIS: FROM SURGERY TO INTERVENTIONAL INTENSIVE CARE
J Werner, S Feuerbach, W Uhl, M W Bu¨chler. Gut 2005;54:426–436

32. Cirugia en la necrosis pancreatica
MANAGEMENT OF ACUTE PANCREATITIS: FROM SURGERY TO INTERVENTIONAL INTENSIVE CARE
J Werner, S Feuerbach, W Uhl, M W Bu¨chler. Gut 2005;54:426–436

34. PANCREATITIS AGUDA
GRAVE
Tratamiento de la necrosis
infectada
• Cirugia
• Endoscopia
• Drenaje percutaneo
• Otros

35. PANCREATITIS AGUDA
GRAVE
• JPN Guidelines for the management of acute pancreatitis: surgical
treatment. Isaji S, TaKada T, Kawarada Y et al. J Hepatobiliary
Pancreat Surg 2006; 13:48-55
•CQ1. Which procedure will best result in a definite diagnosis of infected
pancreatic necrosis ?
•CQ2. What is the indication for surgical intervention in necrotizing pancreatitis ?
•CQ3. How should sterile pancreatic necrosis be managed ?
•CQ4. What is the optimal timing for surgical intervention ?
•CQ5. What is the optimal surgical procedure for infected pancreatic necrosys?
•CQ6. What is the optimal drainage procedure after necrosectomy ?
•CQ7. How should pancreatic abscess be managed ?
•CQ8. What is the indication for surgical drainage in pancreatic abscess?
•CQ9. What are the indications for drainage treatment in pancreatic pseudocysts?
•CQ10. What is the indication for surgical intervention in pancreatic pseudocysts ?

38. PANCREATITIS AGUDA
GRAVE
• What is the optimal surgical procedure for
infected pancreatic necrosys?
Necrosectomia. RECOMENDACIÓN A

39. PANCREATITIS AGUDA
GRAVE

40. PANCREATITIS AGUDA
GRAVE

41. NECROSECT OMIA
PANCREATICA

42. DRENAJE SEUDOQUISTE