Nikhil Kumta, MD, from Weill Cornell Medical College in New York, New York, USA presents this VideoGIE case “Cleaning the paracolic gutter: transcutaneous endoscopic necrosectomy through a fully covered metal esophageal stent.”
Transgastric endoscopic necrosectomy with nasocystic lavage is accepted as one of the standards of care for the management of walled-off necrosis secondary to acute pancreatitis. In severe cases, the extent of necrosis and inflammation can extend toward the retroperitoneal spaces near the paracolic gutters. Traditionally, those patients have required percutaneous or surgical drainage. In this video, we demonstrate transcutaneous endoscopic necrosectomy through a fully covered metal esophageal stent.
The large retroperitoneal collection was initially accessed by interventional radiology with a percutaneous catheter. Using sterile technique, wire access to the collection was obtained through the percutaneous drain. The cutaneocystic tract was dilated before deploying a fully covered metal esophageal stent into the collection, creating a conduit to the infected necrosis. Trancutaneous necrosectomy and placement of a cutaneocystic drain for lavage allowed resolution of the collection after 2 sessions. The metal stent was then removed and the patient did not have any clinical or radiographic recurrence.
This video highlights the ability to perform transcutaneous endoscopic necrosectomy in areas of the body previously only accessed via percutaneous or surgical approach.
Understanding the technique for transcutaneous endoscopic necrosectomy is important for advanced endoscopists performing this procedure.
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