The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Percutaneous retroperitoneal endoscopic necrosectomy.

It replaces the previous guidance on Percutaneous pancreatic necrosectomy (NICE interventional procedure guidance, December 2003).  

Description

The pancreas produces juices that contain substances (enzymes) that help to digest food. Sometimes these substances can attack the pancreas itself. This can happen if the tube that normally takes the juices to the gut becomes blocked. This can cause swelling of the pancreas and severe pain in the abdomen (acute pancreatitis). Some patients with acute pancreatitis develop a complication called necrosis, when part of the pancreas is destroyed.  This is a serious condition with high risk of death, and removal of the dead tissue is required as part of the management.

The usual way of removing the destroyed part of the pancreas is by open surgery. Percutaneous retroperitoneal endoscopic necrosectomy is an alternative treatment option where a thin telescope, inserted through a small cut in the side above the hip, is used to wash out and remove the dead tissue.

Coding recommendations

J57.6 Pancreatic necrosectomy

Y75.2 Laparoscopic approach to abdominal cavity NEC

Note: Drainage performed in addition would be coded to J66.1Percutaneous drainage of lesion of pancreas and insertion of cystogastrostomy tube NEC,  or J66.2 1Percutaneous drainage of lesion of pancreas and insertion of temporary external drain HFQ, or J66.3 Percutaneous drainage of lesion of pancreas NEC (Includes needle aspiration of pancreas NEC).

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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