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Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study
- Source :
- World Journal of Gastroenterology
- Publication Year :
- 2020
- Publisher :
- Baishideng Publishing Group Inc., 2020.
-
Abstract
- Background Endoscopic drainage of walled-off necrosis (WON) is still a challenge due to stent-associated problems. We explored endoscopic gastric fenestration (EGF) as an innovative alternative intervention. Aim To assess the feasibility, efficacy and safety of EGF for WON. Methods Between March 2019 and March 2020, five patients with symptomatic WON in close contact with the stomach wall were treated by EGF. Endoscopic ultrasound (EUS) was used to select appropriate sites for gastric fenestration, which then proceeded layer by layer as in endoscopic submucosal dissection. Both the stomach muscularis propria and pseudocyst capsule were penetrated. Fenestrations were expanded up to 1.5-3 cm for drainage or subsequent necrosectomy. Results EGF failed in Case 1 due to nonadherence of WON to the gastric wall. EGF was successfully implemented in the other four cases by further refinement of fenestration site selection according to computed tomography, endoscopy and EUS features. The average procedure time for EGF was 124 min (EUS assessment, 32.3 min; initial fenestration, 28.8 min; expanded fenestration, 33 min), and tended to decrease as experience gradually increased. The diameter of the fenestration site was 1.5-3 cm, beyond the caliber of a lumen-apposing metal stent (LAMS), to ensure effective drainage or subsequent necrosectomy. Fenestration sites showed surprising capacity for postoperative self-healing within 1-3 wk. No EGF-related complications were seen. WON disappeared within 3 wk after EGF. In Case 3, another separate WON, treated by endoscopic LAMS drainage, recurred within 4 d after LAMS removal due to stent-related hemorrhage, and resolved slowly over almost 3 mo. No recurrences were observed in the five patients. Conclusion EGF is an innovative and promising alternative intervention for WON adherent to the gastric wall. The challenge resides in the gauging of actual adherence and in selecting appropriate fenestration sites.
- Subjects :
- Endoscopic ultrasound
medicine.medical_specialty
Endoscopic gastric fenestration
medicine.medical_treatment
Pilot Projects
Endosonography
Necrosis
03 medical and health sciences
0302 clinical medicine
Retrospective Study
Walled-off necrosis
medicine
Humans
Gastric wall
Retrospective Studies
Lumen-apposing metal stents
medicine.diagnostic_test
business.industry
Stomach
Gastroenterology
Stent
Capsule
Endoscopy
General Medicine
Stent-related complications
Surgery
Treatment Outcome
medicine.anatomical_structure
030220 oncology & carcinogenesis
Walled off necrosis
Drainage
Stents
030211 gastroenterology & hepatology
Neoplasm Recurrence, Local
Fenestration
business
Subjects
Details
- ISSN :
- 10079327
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- World Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....ab4888e260d5a9df1f26fc37d1b2d5d4