Hydrogen Peroxide, One Way or Another, Appears Beneficial During Endoscopic Necrosectomy
Bret T. Petersen, MD, MASGE, reviewing Messallam AA, et al. Am J Gastroenterol 2020 Nov 3.
Management of walled-off pancreatic necrosis often benefits from direct transmural endoscopic necrosectomy. This retrospective chart review assessed the utility of hydrogen peroxide (H2O2) lavage as an ancillary intervention during endoscopic necrosectomy at 9 centers over a 7-year interval. Overall, technical success was achieved in all 204 patients included in the study, and clinical success (resolution within 6 months) was achieved in 81% (166/189). The clinical success rate was higher with the use of H2O2 lavage during endoscopic necrosectomy than without (93.8% vs 78.9%; P=.002), when administered using highly varied parameters and techniques. Multivariate analysis of a smaller matched subset of study patients confirmed both higher clinical success (odds ratio [OR], 3.33; P=.033) and earlier resolution (OR, 2.27; P<.001), with no difference in overall complication rates (5.2% vs 7.7%; P=.30), postprocedure bleeding (7 vs 9; P=.25), infection (1 vs 2; P=.58), or perforation (2 vs 3; P=.66). Procedures employing H2O2 lavage were shorter than those without (52.0 ± 35.0 minutes vs 72.8 ± 45.6 minutes; P<.001).
COMMENTEndoscopic necrosectomy utilization and techniques are variable among centers and individual endoscopists. Similarly, this study confirms variability in volumes, dilutions, timing, and techniques employed for H2O2 lavage. Nevertheless, and most importantly, this retrospective series demonstrated overall safety as well as a likely benefit from lavage. Although diligence in necrosectomy performance is variable and likely important, the inclusion of H2O2 lavage correlated with both clinical benefit and shorter duration of procedures. Randomized controlled trials are warranted.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Messallam AA, Adler DG, Shah RJ, et al. Direct endoscopic necrosectomy with and without hydrogen peroxide for walled-off pancreatic necrosis: a multicenter comparative study. Am J Gastroenterol 2020 Nov 3. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000000987)
