A comparative study on transnasal gastroscopy and conventional gastroscopy for percutaneous endoscopic pancreatic necrosectomy

Abstract

Objective To compare the therapeutic value of transnasal gastroscopy and conventional gastroscopy for infective pancreatic necrosis(IPN) through percutaneous endoscopic necrosectomy(PEN). Methods A total of 24 IPN patients who received PEN for IPN from December 2015 to March 2019 were divided into the conventional gastroscopy group (n=15) and the transnasal gastroscopy group (n=9). The clinical therapeutic indicators such as vital signs, APACHE Ⅱ score changes, operation duration, difference in preoperative and postoperative volumes of peripancreatic necrosis and other indicators were compared between the two groups. Results There was no significant difference in the variation curve fitting of APACHE Ⅱ scores between the two groups (t=0.378, P=0.710). The operation time of the transnasal gastroscopy group was significantly shorter than that of the conventional gastroscopy group (119.7±47.4 min VS 172.8±56.2 min, P=0.018). Peripancreatic necrotic volume significantly decreased after operation in the transnasal gastroscopy group (404.03±170.73 mL VS 468.9±137.37 mL, P=0.002), and in the conventional gastroscopy group (499.44±227.17 mL VS 722.50±292.96 mL, P<0.001). There was no significant difference in the decrease extent in the conventional gastroscopy group and the transnasal gastroscopy group (223.06±212.92 mL VS 64.87±54.94 mL, P= 0.094). Conclusion On the condition of poor drainage of percutaneous catheter drainage, PEN can significantly reduce the range of necrotic lesions. Transnasal gastroscopy has the advantages in operation time in PEN and clearing deep abscess cavities over conventional gastroscopy. Key words: Pancreatitis; Percutaneous endoscopic necrosectomy; Infective pancreatic necrosis