TECHNIQUE AND MANAGEMENT OF TRANSMURAL NASO-CYST CONTINUOUS IRRIGATION THERAPY FOR WALLED-OFF NECROSIS

Abstract

Endoscopic necrosectomy is performed for patients with walled off necrosis (WON) that does not respond to endoscopic ultrasound (EUS)-guided drainage. However, endoscopic necrosectomy is associated with high rates of adverse events and it is a highly invasive procedure. The addition of transmural naso-cyst continuous irrigation (TNCCI) to EUS-guided drainage can help to avoid endoscopic necrosectomy. TNCCI is performed by inserting an external tube and an internal tube from the gastroduodenal lumen into the WON under EUS guidance and then the WON is continuously irrigated with saline. In cases in which this procedure is ineffective, internal tubes are inserted into the WON under endoscopic guidance and then TNCCI is performed. In TNCCI, necrotic material can be removed by continuously irrigating the WON without performing endoscopic necrosectomy. EUS-guided drainage with TNCCI is an effective and safe approach to treat WON. We recommend that this method is performed before considering endoscopic necrosectomy.