Serial percutaneous endoscopic necrosectomy (SPEN) after initial VARD for necrotizing pancreatitis: a retrospective single-center observational study

INTRODUCTION: Necrotizing pancreatitis (NP), a severe form of acute pancreatitis (AP), is linked to lower survival rates. Treatment strategies have shifted towards less invasive, step-up approaches, favoring minimally invasive procedures. In this study, we report on the potential of combining the minimally invasive surgical approach with endoscopic necrosectomy as a novel treatment strategy, termed serial percutaneous endoscopic necrosectomy (SPEN), for patients with therapy-refractory NP. MATERIAL AND METHODS: A cohort of 19 patients suffering from therapy-refractory NP, defined as persistent necroses after drainage treatment and subsequent video-assisted retroperitoneal debridement (VARD), was treated with SPEN upon failure of the above stated. In contrast to surgery, SPEN does not require general anesthesia or an operating theater. The results were compared with the current data on alternative treatments. RESULTS: The investigated cohort consisted of severely ill patients as most patients experienced organ failure as well as severe disease progression in need of intensive-care unit admission. SPEN was performed 4.3 ± 3.8 times, ranging from 1 to 14 procedures per individual. According to the current Clavien-Dindo classification, only "mild" and no major SPEN procedure-associated complications can be observed. CONCLUSION: In this report, we present our experience with a novel treatment approach combining surgery and endoscopic interventions for the treatment of NP. While sparing resources, SPEN was shown to be safe and effective. Favorable implications are implied owing to the combination of the best of two worlds: surgery, with its capacity for extensive necrosectomy and endoscopic necrosectomy, which is valued for its applicability as a flexible, low-grade invasive but effective tool that may be dynamically employed depending on individual disease progression.