Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jul 10;13(14):2321.
doi: 10.3390/diagnostics13142321.

Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device

Cecilia Binda  1 , Chiara Coluccio  1 , Antonio Vizzuso  2 , Alessandro Sartini  1 , Monica Sbrancia  1 , Alessandro Cucchetti  3   4 , Emanuela Giampalma  2 , Stefano Fabbri  1 , Giorgio Ercolani  3   4 , Carlo Fabbri  1
Affiliations
Case Reports

Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device

Cecilia Binda et al. Diagnostics (Basel). .

Abstract

Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting.

Keywords: EUS-guided drainage; EndoRotor; direct endoscopic necrosectomy; necrotizing pancreatitis; walled-off pancreatic necrosis.

PubMed Disclaimer

Conflict of interest statement

Cecilia Binda is lecturer for Boston Scientific, Steris, Q3 Medical, Fujifilm. Chiara Coluccio is lecturer for Steris. Carlo Fabbri is consultant for Boston Scientific and lecturer for Steris and Q3 Medical. All of the other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
View of recurrent collection at pre-operative CT-scan. Red arrow points to the splenic artery inside the collection.
Figure 2
Figure 2
Fluoroscopic view of selective cannulation of splenic artery with a catheter inserted through the common femoral artery.
Figure 3
Figure 3
EndoRotor catheter coming out from the operative channel of the endoscope into the necrotic tissue of the collection.
Figure 4
Figure 4
CT-scan at 6th month follow-up, showing the complete resolution of necrosis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Banks P.A., Bollen T.L., Dervenis C., Gooszen H.G., Johnson C.D., Sarr M.G., Tsiotos G.G., Vege S.S. Classification of acute pancreatitis–2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111. doi: 10.1136/gutjnl-2012-302779. - DOI - PubMed
    1. Baron T.H., DiMaio C.J., Wang A.Y., Morgan K.A. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020;158:67–75.e1. doi: 10.1053/j.gastro.2019.07.064. - DOI - PubMed
    1. Arvanitakis M., Dumonceau J.M., Albert J., Badaoui A., Bali M.A., Barthet M., Besselink M., Deviere J., Ferreira A.O., Gyökeres T., et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018;50:524–546. doi: 10.1055/a-0588-5365. - DOI - PubMed
    1. Trikudanathan G., Wolbrink D.R.J., van Santvoort H.C., Mallery S., Freeman M., Besselink M.G. Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach. Gastroenterology. 2019;156:1994–2007.e3. doi: 10.1053/j.gastro.2019.01.269. - DOI - PubMed
    1. Carter C.R., McKay C.J., Imrie C.W. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: An initial experience. Ann. Surg. 2000;232:175–180. doi: 10.1097/00000658-200008000-00004. - DOI - PMC - PubMed

Publication types

LinkOut - more resources