scholarly journals Multiple transluminal gateway technique with transplantation of lumen‐apposing metal stent for direct endoscopic necrosectomy in a patient with infected walled‐off pancreatic necrosis

2021 ◽  
Author(s):  
Takuji Iwashita ◽  
Yuhei Iwasa ◽  
Masahito Shimizu
Keyword(s):  
Pancreatic Necrosis ◽  
Metal Stent ◽  
Endoscopic Necrosectomy

scholarly journals Endoscopic necrosectomy of walled-off pancreatic necrosis by large-bore percutaneus metal stent: a new opportunity?

2018 ◽  
Vol 06 (03) ◽  
pp. E274-E278 ◽  
Author(s):  
Andrea Tringali ◽  
Salvatore Vadalà di Prampero ◽  
Vincenzo Bove ◽  
Vincenzo Perri ◽  
Antonio La Greca ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Duodenal Wall ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Percutaneous Approach ◽  
Endoscopic Necrosectomy

Abstract Background and study aims Endoscopic drainage of walled-off pancreatic necrosis (WOPN) is feasible when contact with the gastric or duodenal wall is present; when WOPN cannot be accessed endoscopically, a percutaneous approach can be considered. Percutaneous use of esophageal self-expandable metal stents (SEMS) to establish access to a WOPN cavity was evaluated.

Retrieval and reuse of a dislodged lumen-apposing metal stent during endoscopic necrosectomy for pancreatic necrosis

2016 ◽  
Vol 84 (2) ◽  
pp. 364 ◽  
Author(s):  
Nikhil A. Kumta ◽  
Rushabh Doshi ◽  
Porfirio J. Reinoso ◽  
Amy Tyberg ◽  
Michel Kahaleh
Keyword(s):  
Pancreatic Necrosis ◽  
Metal Stent ◽  
Endoscopic Necrosectomy

scholarly journals EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Cecilia Binda ◽  
Monica Sbrancia ◽  
Marina La Marca ◽  
Dora Colussi ◽  
Antonio Vizzuso ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Pancreatic Necrosis ◽  
Multiorgan Failure ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Dual Approach ◽  
Endoscopic Necrosectomy ◽  
Paracolic Gutter ◽  
Percutaneous Endoscopic Necrosectomy ◽  
Self Expandable Metal Stent

Abstract Background Endoscopic ultrasound-guided drainage is suggested as the first approach in the management of symptomatic and complex walled-off pancreatic necrosis. Dual approach with percutaneous drainage could be the best choice when the necrosis is deep extended till the pelvic paracolic gutter; however, the available catheter could not be large enough to drain solid necrosis neither to perform necrosectomy, entailing a higher need for surgery. Therefore, percutaneous endoscopic necrosectomy through a large bore percutaneous self-expandable metal stent has been proposed. Case presentation In this study, we present the case of a 61-year-old man admitted to our hospital with a history of sepsis and persistent multiorgan failure secondary to walled-off pancreatic necrosis due to acute necrotizing pancreatitis. Firstly, the patient underwent transgastric endoscopic ultrasound-guided drainage using a lumen-apposing metal stent and three sessions of direct endoscopic necrosectomy. Because of recurrence of multiorgan failure and the presence of the necrosis deeper to the pelvic paracolic gutter at computed tomography scan, we decided to perform percutaneous endoscopic necrosectomy using an esophageal self-expandable metal stent. After four sessions of necrosectomy, the collection was resolved without complications. Therefore, we perform a revision of the literature, in order to provide the state-of-art on this technique. The available data are, to date, derived by case reports and case series, which showed high rates both of technical and clinical success. However, a not negligible rate of adverse events has been reported, mainly represented by fistulas and abdominal pain. Conclusion Dual approach, using lumen apposing metal stent and percutaneous self-expandable metal stent, is a compelling option of treatment for patients affected by symptomatic, complex walled-off pancreatic necrosis, allowing to directly remove large amounts of necrosis avoiding surgery. Percutaneous endoscopic necrosectomy seems a promising technique that could be part of the step-up-approach, before emergency surgery. However, to date, it should be reserved in referral centers, where a multidisciplinary team is disposable.

scholarly journals What is the Impact of the Proportion of Solid Necrotic Content on the Number of Necrosectomies during EUS-Guided Drainage using Lumen-Apposing Metallic Stents of Pancreatic Walled-off Necrosis ?

2020 ◽  
Vol 29 (4) ◽  
pp. 623-628
Author(s):  
Andrada Seicean ◽  
Cristina Pojoga ◽  
Ofelia Mostean ◽  
Sorana Bolboaca ◽  
Madalina Ilie ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Clinical Success ◽  
Metal Stents ◽  
Metal Stent ◽  
Endoscopic Necrosectomy ◽  
Medical Centers ◽  
One Step ◽  
Walled Off Necrosis ◽  
The Impact

Background and Aims: The fully-covered, lumen apposing metal stents are designed for one step placement, facilitating the direct endoscopic necrosectomy into the walled-off pancreatic necrosis. However, the prediction of the number of necrosectomy sessions in these patients is not known. This study evaluated the association between the proportion of solid necrotic material inside walled-off necrosis, as assessed during the endosonography placement of a lumen apposing metal stent, and the number of necrosectomies subsequently required. Methods: Patients from three tertiary medical centers with symptomatic walled off pancreatic necrosis (pain, infection, gastric/biliary obstruction) at more than 4 weeks after onset of acute pancreatitis were retrospectively analysed. Proportion of solid necrotic debris was estimated during endosonography procedure of lumen apposing metal stents placement. Necrosectomy was performed when obstruction or inflammation occurred subsequently. Lumen apposing metal stents were removed after clearance of necrotic content. Results: In 46 patients with successful lumen apposing metal stents placement, necrosectomy was performed in 39 patients (72.78%). Performance of 3 or more necrosectomies was significantly associated with more than 50% pancreatic necrosis (p=0.032), but not with walled-off pancreatic necrosis size or location. Necrotic infection during lumen apposing metal stents stenting was associated with hypoalbuminemia, but not with necrosectomy requirement. Clinical success after a median follow-up of 13.37 months was 87%. Conclusions: Walled-off pancreatic necrosis with more than 50% solid necrotic content were associated with more necrosectomy procedures, requiering longer endoscopy time, intravenous sedations, and higher costs.

Endoscopic necrosectomy of walled-off pancreatic necrosis using a lumen-apposing metal stent and irrigation technique

2015 ◽  
Vol 30 (6) ◽  
pp. 2592-2602 ◽  
Author(s):  
Joan B. Gornals ◽  
Claudia F. Consiglieri ◽  
Juli Busquets ◽  
Silvia Salord ◽  
Meritxell de-la-Hera ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Metal Stent ◽  
Endoscopic Necrosectomy
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