Amy Tyberg, MD, from Weill Cornell Medical College in New York, New York, USA shares this video case “Drainage of infected pancreatic necrosis by using 2 lumen-apposing metal stents, a nasocystic drain, and hydrogen peroxide.”
This case describes a 55-year-old man with an infected, 16cm walled-off necrotic pancreatic fluid collection. Standard cystgastrostomy into the proximal part of the collection with a single lumen-apposing metal stent (LAMS) was unsuccessful in resolving the collection. Thus, a second LAMS was placed via cystgastrostomy into the distal part of the collection. Successful resolution of the collection was then achieved.
Endoscopic drainage of pancreatic fluid collections (PFCs) is now the preferred management option when feasible. In necrotic collections, endoscopic drainage via cystgastrosotmy in addition to direct necrosectomy with mechanical debridement and irrigation with both hydrogen peroxide and nasocystic drainage is often required. The advent of large-diameter metal stents for this purpose has allowed for improved drainage as well as repeated passage of an endoscope into the cavity for necrosectomy. In a majority of patients, complete resolution of the collection is achieved using this strategy. However, in rare cases when the collection is large or contains multiple pockets, several drainage points may be required for successful resolution.
In this case, 2 LAMSs were placed into the proximal and distal portions of the collection. By improving the surface area for drainage and allowing for irrigation through the cavity itself, successful resolution was achieved. This case shows us that successful resolution of PFCs can be achieved without the need for more invasive alternatives even in large and initially-resistant collections.
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