Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome

doi:10.5847/wjem.j.1920-8642.2015.01.004

Abstract

Abstract:

BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery (ENOTES) in treating severe acute pancreatitis (SAP) complicated with abdominal compartment syndrome (ACS).
METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.
RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II (APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day (P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group (P<0.05). There were significant differences in complications and mortality between the two groups (P<0.01).
CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.

Key words: Embryonal natural orifice transluminal endoscopic surgery, Flexible endoscope, Peritoneal lavage, Peritoneal dialysis, Severe acute pancreatitis, Abdominal compartment syndrome

Hui-ming Zhu, Shao-qing Guo, Xiu-min Liao, Li Zhang, Li Cai. Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome[J]. World Journal of Emergency Medicine, 2015, 6(1): 23-28.

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Variables	ENOTES group	Operative group	P
Age (years)	52.91±14.81	51.09±17.91	0.300
Gender (male/female)	18/14	20/12	0.813
CRP value (mg/L)	210.66±70.23	219.25±86.25	0.780
Serum amylase value (U/L)	993.81±880.57	1115.00±638.85	0.710
APACHE II score	14.76±6.68	14.82±2.09	0.395
Organ dysfunction
Respiratory dysfunction	87.5% (28/32)	84.4% (27/32)^*
Renal dysfunction	37.5% (12/32)	43.8% (14/32)^*
Peritonitis	93.8% (30/32)	96.4% (31/32)^*
Enteroplegia	96.8% (31/32)	96.8% (31/32)^*

Variables	ENOTES group	Operative group	P
Operative time (minutes)	75.14±20.07	160.09±67.31	<0.001
Operative frequency	1.13±0.35	2.00±0.89	<0.001
Hospital stay (days)	21.41±9.04	61.63±46.69	<0.001

Groups	n	Before operation	First day after operation	Third day after operation	Fifth day after operation	Seventh day after operation
ENOTES group	32	0.26±0.34^*	1.68±1.02	2.98±1.09	4.30±1.75	4.68±1.54
Operative group	32	0.25±0.17^*	0.24±0.16	2.69±0.53	4.00±1.35	4.62±1.02
P		>0.05	<0.05	>0.05	>0.05	>0.05

Groups	n	Before operation	First day after operation	Third day after operation	Fifth day after operation	Seventh day after operation
ENOTES group	32	22.57±7.48	12.09±5.23	9.41±3.12	7.878±2.24	7.15±1.34
Operative group	32	24.00±5.62	12.55±2.88	8.82±4.14	8.820±4.14^Δ	7.54±3.18
P	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

Groups	n	Before operation	First day after operation	Third day after operation	Fifth day after operation	Seventh day after operation
ENOTES group	32	14.82±4.00	10.05±2.43	8.74±2.48	7.18±2.72	6.35±2.78
Operative group	32	17.00±6.78	13.38±3.12	12.92±4.03	10.08±3.30	8.26±4.18
P	>0.05	>0.05	>0.05	>0.05	<0.05	>0.05