SIR 2024
Gastrointestinal Interventions
Jorge Lopera, MD, FSIR (he/him/his)
Attending
UT Health Science Center in San Antonio
Financial relationships: Full list of relationships is listed on the CME information page.
A retrospective review of patients that underwent PN in the last 5 years was performed in a single tertiary medical center. Patients that underwent combined PN with GI were excluded. Clinical indications, PN technique, outcome and complications were recorded. Technical success was defined to resolution of the collections with eventual drain removal.
Twenty one patients (6 F, 15 M, ages 12-83, mean 44 ) underwent IR operated endoscopic assisted PN using a 20 Fr flexible cystoscope and a combination of baskets and/or forceps The number of PN sessions varied from 1 to 7 ( mean 1.7 ). Eleven patients had wall-off necrosis after necrotizing pancreatitis, 4 patients had pancreatic leaks after surgery (n=3) or trauma (n=1), 2 patients had necrotic colon cancer with infection, three had necrotic liver collections with two having bilio-colonic fistulas , and one patient had fat necrosis after pelvic fracture .
Results:
Successful removal on necrotic material was obtained in all patients , sixteen patients had the drains removed. Two with necrotic tumors failed to have the drains removed and died later with drains in place. Two patients have ongoing treatment. On patient with NP died of multiorgan failure related to the pancreatitis with drain in place. One major complication occurred in a liver patient with erosion of the large bore drain in the portal vein requiring placement of a stent graft. Associated fistulas with biliary (n=2) or GI (n=6) tracts were embolized as part of the treatment in 6 patients.
Conclusion:
PN is a very useful technique for the treatment of complex fluid collections associated with in different clinical scenarios . Higher failure rate is seen in patients with necrotic tumors. Embolization of associated biliary and/or enteric fistulas can be performed as part of the procedure.