Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2021; 12(04): 242-244
DOI: 10.1055/s-0041-1741388
Endoscopy Video

Combined EUS LAMS and Percutaneous Fully Covered SEMS-Guided Direct Endoscopic Necrosectomy (e-DEN + p-DEN) for Walled-Off Pancreatic Necrosis with Paracolic Extension

Ashish Gandhi 
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
,
Mangesh Borkar
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
,
Harsh Bapaye 
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
2   Department of Medicine, Byramjee Jeejeebhoy Medical College, Pune, Maharashtra, India
,
Rajendra Pujari
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
,
Amol Bapaye 
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Management of infected lesser sac walled-off pancreatic necrosis (WOPN) is technically challenging and involves endoscopic ultrasound (EUS)-guided transmural drainage using either lumen-apposing metal stent (LAMS) or multiple plastic stents as the standard approach. A step-up approach—drainage followed by additional direct endoscopic necrosectomy (DEN) whenever required—has been a standard recommendation. Collections extending to the paracolic gutter are difficult to manage endoscopically and often require additional surgical intervention. In this video case, we describe a combined approach using EUS-guided LAMS and percutaneous fully covered self-expandable metal stent-guided DEN (e-DEN + p-DEN) for successful management of an infected lesser sac WOPN with paracolic extension.

Keywords

walled-off pancreatic necrosis - WON - WOPN - percutaneous direct endoscopic necrosectomy - direct endoscopic necrosectomy - DEN - DEN - p-DEN

Financial Disclosure

None.


Consent

Written informed consent was obtained from patient for publication of this report.




Publication History

Article published online:
18 January 2022

© 2022. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 van Santvoort HC, Besselink MG, Bakker OJ. et al; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362 (16) 1491-1502
    CrossrefPubMedGoogle Scholar
  • 2 Thorsen A, Borch AM, Novovic S, Schmidt PN, Gluud LL. Endoscopic necrosectomy through percutaneous self-expanding metal stents may be a promising additive in treatment of necrotizing pancreatitis. Dig Dis Sci 2018; 63 (09) 2456-2465
    CrossrefPubMedGoogle Scholar
  • 3 Saumoy M, Kumta NA, Tyberg A. et al. Transcutaneous endoscopic necrosectomy for walled-off pancreatic necrosis in the paracolic gutter. J Clin Gastroenterol 2018; 52 (05) 458-463
    CrossrefPubMedGoogle Scholar