Nikhil A. Kumta, MD from the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York, USA presents this video case, “Endoscopic necrosectomy by using a transgastric fully covered esophageal metal stent.”
Infected walled off pancreatic necrosis is an adverse event of pancreatitis requiring drainage and debridement for definitive management. Surgery is associated with considerable mortality. Direct endoscopic necrosectomy has been shown to be safe and efficacious. In this video, we demonstrate endoscopic ultrasound guided placement of a transgastric fully covered esophageal metal stent to facilitate drainage and endoscopic debridement in a patient with infected pancreatic necrosis.
The area of necrosis was located with an echoendoscope. Transgastric puncture was made with a 19-gauge needle into the area of necrosis. Over a guidewire, a fistula was created between the stomach and pancreas with a dilating balloon. An 18 × 60 mm, fully covered esophageal metal stent was deployed across the fistula. The stent was centered within the necrotic cavity to decrease the risk of bleeding and perforation. The stent facilitated a conduit for drainage of cystic contents and access for endoscopic irrigation and debridement.
Figure 1. Endoscopic vision through the metal stent into the cystic cavity.
With the advent of lumen apposing metal stents, endoscopic ultrasound guided drainage of symptomatic or infected pseudocysts and pancreatic necrosis is the treatment of choice in patients with feasible transgastric or transduodenal access.
Understanding the technique for endoscopic ultrasound guided drainage is important for advanced endoscopists performing this procedure.
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