Novel single transluminal gateway transcystic multiple drainages after EUS-guided drainage for complicated multilocular walled-off necrosis (with videos)

摘要

EUS-guided drainage of pancreatic fluid collection is a minimally invasive procedure and has become standard therapy worldwide for pancreatic pseudocyst and pancreatic walled-off necrosis (WON).1"3 The conventional single transluminal gateway technique (SGT) using transmural placement of single or multiple plastic or metal stents is sufficient for unilocular pancreatic fluid collections. In contrast, WON contains necrotic debris, and effective, prompt improvement is limited when SGT is used because the collections are often multiseptated. Furthermore, infected WON requires aggressive therapy such as direct endoscopic necrosectomy (DEN) for the removal of necrotic tissue.5 DEN has improved the success rate of endoscopic treatment of WON, but refractory cases remain and are resistant to treatment using SGT plus DEN.