1. EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature
- Author
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Emanuela Giampalma, D Colussi, Marina La Marca, Monica Sbrancia, Cecilia Binda, Matteo Tomasoni, Carlo Fabbri, Luca Ansaloni, Antonio Vizzuso, Vanni Agnoletti, Binda C., Sbrancia M., La Marca M., Colussi D., Vizzuso A., Tomasoni M., Agnoletti V., Giampalma E., Ansaloni L., and Fabbri C.
- Subjects
Male ,Abdominal pain ,medicine.medical_specialty ,Percutaneous ,RD1-811 ,medicine.medical_treatment ,Self Expandable Metallic Stents ,Lumen (anatomy) ,Case Report ,Lumen-apposing metal stent ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous endoscopic necrosectomy ,Paracolic gutters ,medicine ,Humans ,business.industry ,Pancreatitis, Acute Necrotizing ,Walled-off pancreatic necrosis ,RC86-88.9 ,Necrotizing pancreatiti ,Necrotizing pancreatitis ,Stent ,Medical emergencies. Critical care. Intensive care. First aid ,Middle Aged ,Surgery ,Catheter ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Walled off necrosis ,Emergency Medicine ,Drainage ,030211 gastroenterology & hepatology ,Stents ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Eus guided drainage ,Endoscopic necrosectomy - Abstract
Background Endoscopic ultrasound-guided drainage is suggested as the first approach in the management of symptomatic and complex walled-off pancreatic necrosis. Dual approach with percutaneous drainage could be the best choice when the necrosis is deep extended till the pelvic paracolic gutter; however, the available catheter could not be large enough to drain solid necrosis neither to perform necrosectomy, entailing a higher need for surgery. Therefore, percutaneous endoscopic necrosectomy through a large bore percutaneous self-expandable metal stent has been proposed. Case presentation In this study, we present the case of a 61-year-old man admitted to our hospital with a history of sepsis and persistent multiorgan failure secondary to walled-off pancreatic necrosis due to acute necrotizing pancreatitis. Firstly, the patient underwent transgastric endoscopic ultrasound-guided drainage using a lumen-apposing metal stent and three sessions of direct endoscopic necrosectomy. Because of recurrence of multiorgan failure and the presence of the necrosis deeper to the pelvic paracolic gutter at computed tomography scan, we decided to perform percutaneous endoscopic necrosectomy using an esophageal self-expandable metal stent. After four sessions of necrosectomy, the collection was resolved without complications. Therefore, we perform a revision of the literature, in order to provide the state-of-art on this technique. The available data are, to date, derived by case reports and case series, which showed high rates both of technical and clinical success. However, a not negligible rate of adverse events has been reported, mainly represented by fistulas and abdominal pain. Conclusion Dual approach, using lumen apposing metal stent and percutaneous self-expandable metal stent, is a compelling option of treatment for patients affected by symptomatic, complex walled-off pancreatic necrosis, allowing to directly remove large amounts of necrosis avoiding surgery. Percutaneous endoscopic necrosectomy seems a promising technique that could be part of the step-up-approach, before emergency surgery. However, to date, it should be reserved in referral centers, where a multidisciplinary team is disposable.
- Published
- 2021