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. 2010 Mar;4(1):140-5.
doi: 10.5009/gnl.2010.4.1.140. Epub 2010 Mar 30.

EUS-Guided Multitransgastric Endoscopic Necrosectomy for Infected Pancreatic Necrosis with Noncontagious Retroperitoneal and Peritoneal Extension

Affiliations

EUS-Guided Multitransgastric Endoscopic Necrosectomy for Infected Pancreatic Necrosis with Noncontagious Retroperitoneal and Peritoneal Extension

Ja Eun Koo et al. Gut Liver. 2010 Mar.

Abstract

Endoscopic necrosectomy was introduced as a safe and effective treatment modality for infected pancreatic necrosis. Although there have been many reports of endoscopic drainage of retroperitoneal pancreatic necrosis, the optimal endoscopic management of pancreatic necrosis extending to the noncontagious retroperitoneal and peritoneal spaces has yet to be established. We report herein a patient with infected pancreatic necrosis with noncontagious retroperitoneal and peritoneal extension who was treated successfully by endoscopic ultrasound (EUS)-guided multiple cystogastrostomy and endoscopic necrosectomy. EUS-guided multitransgastric necrosectomy may be technically feasible and effective for the management of infected pancreatic necrosis with noncontagious retroperitoneal and peritoneal extension that demonstrates suitable anatomy. Further studies to assess the efficacy and safety of this technique are needed before its routine clinical use can be recommended.

Keywords: Endoscopic necrosectomy; Endoscopic ultrasound; Infected pancreatic necrosis; Pancreatitis; Transmural drainage.

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Figures

Fig. 1
Fig. 1
(A, B) CT images showing peripancreatic necrosis; this lesion extended to the retroperitoneal and peritoneal cavity as far as the left pararenal space. (C, D) After multitransgastric endoscopic necrosectomy, a follow-up CT also showed the near resolution of the infected peripancreatic necrosis. The time interval between the images in panels A and B and those in panels C and D was 49 days.
Fig. 2
Fig. 2
(A) Linear endoscopic ultrasound identified the pancreatic necrotic cavity at the posterior wall of the high body. (B-D) After balloon dilatation, an endoscopic necrosectomy of the retroperitoneal area was performed. A large amount of necrotic materials was removed.
Fig. 3
Fig. 3
(A) Linear endoscopic ultrasound identified the pancreatic necrotic cavity with echogenic debris at the posterior wall of the low body. (B-D) After balloon dilatation, an endoscopic necrosectomy of the peritoneal area was performed. A large amount of necrotic materials and pus were removed.
Fig. 4
Fig. 4
CT showing the concept of multitransgastric necrosectomy. (A) Necrosectomy of the peritoneal space (curved arrow). Inset: cross-sectional view of the transgastric approach to the peritoneal space. (B) Necrosectomy of the retroperitoneal space (arrow).

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