Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study)
Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study)
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DOI：
10.1136/gut.2008.163733
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发表时间：
2009-09-01
期刊：
影响因子：
24.5
通讯作者：
Roesch, T.
中科院分区：
文献类型：
--
作者：
Seifert, H.;Biermer, M.;Roesch, T.
背景资料：与胰周积液的内窥镜透壁引流一样，可以扩展相同的经腔入路，以将内窥镜通过胃肠壁引入腹膜后腔，并在直接视觉控制下清除感染的胰腺坏死。本研究报告的第一个大系列与长期follow-up.Methods：数据为所有患者进行腔内内镜切除（ESTA）胰腺坏死在1999年和2005年之间在六个不同的中心进行了回顾性收集，患者进行了前瞻性随访，直到2008年。最初的病人和治疗结果的数据被记录，作为长期results.Results：93例患者（63名男性，30名女性，平均年龄57岁）进行了平均6次干预开始于平均43天后，严重急性胰腺炎的攻击。在建立经腔进入坏死腔和随后的内窥镜坏死切除术后，80%的患者获得了初步临床成功，30天时并发症发生率为26%，死亡率为7.5%。经过平均43个月的随访，84%的最初成功治疗的患者有持续的临床改善，10%接受进一步的内镜和4%接受手术治疗复发腔; 16%患有复发pancreatis.Conclusions：直接经腔内镜切除胰腺坏死是与良好的长期维持高初始疗效;可能发生并发症，相关死亡率约为7.5%。进一步的研究是必要的，以优化内治疗，并确定其作用与手术的临床管理，这样的病人。
Background: As with endoscopic transmural drainage of peripancreatic fluid collections, the same transluminal access can be expanded to introduce an endoscope through the gastrointestinal wall into the retroperitoneum and remove infected pancreatic necroses under direct visual control. This study reports the first large series with long-term follow-up.Methods: Data for all patients undergoing transluminal endoscopic removal of (peri) pancreatic necroses between 1999 and 2005 in six different centres were collected retrospectively, and the patients were followed up prospectively until 2008. The initial patient and treatment outcome data were recorded, as were long-term results.Results: Ninety-three patients (63 men, 30 women; mean age 57 years) underwent a mean of six interventions starting at a mean of 43 days after an attack of severe acute pancreatitis. After establishment of transluminal access to the necrotic cavity and subsequent endoscopic necrosectomy, initial clinical success was obtained in 80% of the patients, with a 26% complication and a 7.5% mortality rate at 30 days. After a mean follow-up period of 43 months, 84% of the initially successfully treated patients had sustained clinical improvement, with 10% receiving further endoscopic and 4% receiving surgical treatment for recurrent cavities; 16% suffered recurrent pancreatitis.Conclusions: Direct transluminal endoscopic removal of pancreatic necroses is associated with good long-term maintenance of the high initial efficacy; complications can occur, with an associated mortality of around 7.5%. Further studies are necessary in order to optimise endotherapy and define its role in relation to surgery in the clinical management of such patients.