Endoscopic Procedure Helpful Against Severe Pancreatitis

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CHICAGO—In a small, preliminary trial, patients with infected necrotizing pancreatitis (severe form of the disease involving devitalized pancreatic tissue) who received a less-invasive procedure, endoscopic transgastric necrosectomy (removal of the pancreatic tissue), had an associated lower risk of major complications and death compared to patients who had surgical necrosectomy, according to a study in the March 14 issue of JAMA.

"Acute pancreatitis is a common and potentially lethal disorder," according to background information in the article. "In the United States alone, more than 50,000 patients are admitted with acute pancreatitis each year. One of the most dreaded complications in these patients is infected necrotizing pancreatitis that leads to sepsis and is often followed by multiple organ failure.

"Most patients with infected necrotizing pancreatitis require necrosectomy," the article continued. "Surgical necrosectomy induces a proinflammatory response and is associated with a high complication rate."

Endoscopic transgastric necrosectomy, a new technique, is a form of natural orifice transluminal endoscopic surgery (NOTES) that is performed under conscious sedation without the need for general anesthesia and potentially reduces the proinflammatory response and risk of procedure-related complications such as multiple organ failure. NOTES has not yet been compared with surgery in a randomized clinical trial for any disease.

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