Drain Irrigation with Vacuum Assistance (DIVA) Necrosectomy in Necrotizing Pancreatitis

This study compares traditional minimally invasive treatment of necrotizing pancreatitis with a novel interventional approach, Drain Irrigation with Vacuum Assistance (DIVA) necrosectomy.

Materials and Methods:

A retrospective review of patients with necrotizing pancreatitis who received a minimally invasive necrosectomy at a tertiary care academic center was performed. These patients received video assisted retroperitoneal debridement (VARD) or endoscopic transgastric necrosectomy (ETN) (n=13) or DIVA (n=6). In the DIVA procedure, a suction device is inserted in a mature drain tract in tandem with an irrigation catheter and vacuum debridement is performed with negative pressure reaching 98.9kPa. Demographic data and pre-procedure severity were recorded. The number of procedures each patient received, time to resolution, and the number and nature of complications were compared between the VARD/ETN and DIVA groups.

Results:

Patients who received DIVA had higher disease severity at presentation (Acute Physiology and Chronic Health Evaluation (APACHE) II score: VARD/ETN vs DIVA, 5.69 vs 15.0, p = 0.014), but reached resolution of abdominal fluid collections more quickly (VARD/ETN vs DIVA, 144.92 vs 84.67 days, p = 0.035). While 1 of 13 (7.7%) of VARD/ETN patients died, all DIVA patients reached resolution with no mortality. DIVA is qualitatively associated with fewer complications, though this difference is not statistically significant (VARD/ETN vs DIVA, 54.8% vs 33.3%, RR 0.62, p = 0.45).

Conclusion:

Patients receiving IR-guided DIVA necrosectomy experienced a faster time to resolution despite an initially more severe presentation, compared to VARD/ETN patients. These preliminary results warrant further research into DIVA’s role in treatment of necrotizing pancreatitis.