Endoscopic Transgastric Necrosectomy in Acute Necrotizing Pancreatitis: First Successful Case in Phramongkutklao Hospital

Abstract

Pancreatic necrosis with the formation of walled-off collection is a known complication of severe acute pancreatitis. Infected wall-off necrosis is associated with a high mortality rate. Open necrosectomy and debridement has traditionally been the gold standard for treatment, but it is related with high morbidity and mortality. The approach to pancreatic necrosectomy has evolved from primary open necrosectomy to minimally-invasive radiologic, surgical and endoscopic procedures. Endoscopic transluminal necrosectomy is a minimally-invasive technique that was introduced in recent years for the treatment of infected walled-off necrosis. An opening is created endoscopically between the gastric lumen and the walled-off necrosis. An endoscope is inserted directly into the cavity to perform endoscopic necrosectomy. In this case, we demonstrate the first successful case in Phramongkutklao hospital which was performed endoscopic necrosectomy through a transgastric fully covered metal stent in a patient with infected pancreatic necrosis.