Endoscopic Pancreatic Necrosectomy

Pancreatic necrosis is a serious complication of acute pancreatitis. After recurring attacks of pancreatitis, tissue within the pancreas may die (necrotize) and later become infected. Doctors can diagnose pancreatic necrosis with a CT scan and then perform pancreatic necrosectomy as an advanced endoscopic outpatient surgery to remove the dead, infected pancreatic tissue.

How to Prepare for a Pancreatic Necrosectomy

Do not eat or drink anything (including water) for 6 hours before the procedure, or after midnight if your appointment is in the morning. Your doctor will let you know if or when you should adjust or stop any medications you take. Because you will be sedated, you will need someone to drive you home after the procedure.

What to Expect

Endoscopic pancreatic necrosectomy is performed during an upper endoscopy. You will lie on your left side for the procedure and receive pain-relieving medication and sedation through an IV line to relax you and make you feel drowsy.

A mouth guard will be placed to protect your teeth and gums. Your throat may also be numbed with a spray to calm the gag reflex. The doctor will insert the endoscope through the mouth, passing it down through the esophagus into the stomach or duodenum (the first part of the small intestine).

Using a combination of endoscopic ultrasound (EUS) and live X-ray images, the doctor inserts a stent from the stomach to the pancreas, which allows any accumulation of pancreatic fluid to drain into the stomach. The endoscope is guided through the stent into the pancreas, and, using a variety of tools inserted through the endoscope, the doctor will then remove the dead pancreatic tissue.

This advanced procedure can range from 1-3 hours. It usually takes more than one procedure to remove all the dead pancreatic tissue. Complete endoscopic necrosectomy may be performed in as few as 2 procedures, but it occasionally takes 4 or 5 procedures. These subsequent endoscopies are performed within 1 or 2 weeks of the initial procedure.

After the procedure, you will be taken to the recovery room while the sedative wears off. You may experience temporary discomfort, such as bloating, nausea, gagging, belching, or sore throat. Your doctor will prescribe an antibiotic for you and discuss any unexpected side effects that may occur along with a plan to address them.