Abstract
Endoscopic necrosectomy for pancreatic fluid collection has been reported as an effective alternative approach to surgical treatment. In many cases with walled-off pancreatic necrosis, it is difficult to accomplish complete resolution of the fluid accumulation with only transenteric or transpapillary drainage. Endoscopic necrosectomy is one of the more radical therapeutic options enabling the removal of necrotic tissues in such cases. In this report, we explain the procedural details of the endoscopic necrosectomy procedure currently performed in Japan. The procedure is initiated by transgastric cyst puncture using a 19-gauge needle under endoscopic ultrasound guidance. The puncture site is then enlarged using a 15-to18-mm caliber balloon catheter to accommodate insertion of an endoscope into the cyst. Necrotic tissue is endoscopically removed by irrigating with water. After necrosectomy, multiple trans-enteric plastic stents for internal drainage and a transnasal drainage tube for continuous irrigation are inserted. Although the endoscopic approach is less invasive compared with surgical necrosectomy, several sessions of treatment may be required to achieve the same results. Also, a fully covered metallic stent can be used instead of multiple plastic stents. Even after the removal of the necrotic tissue, the overall physical condition of the patient must be constantly monitored to check for the occurrence of both procedure-related and nonrelated complications.
To date, reliable evidence for the efficacy and safety of this novel technique is lacking. Further technical improvement and well-designed studies are necessary to achieve procedural standardization and fully understand the meaning of the clinical values in these cases.
