Walled-off pancreatic necrosis (WON) arises as a complication of severe necrotizing pancreatitis. Direct endoscopic necrosectomy (DEN) is a feasible option when the following criteria are met: (1) presence of a mature wall, (2) endoscopically accessible, (3) significant liquefactive necrosis has occurred, (4) absence of significant coagulopathy, (5) absence of aneurysmal vessels within the WON, and (6) symptomatic. Access to the WON cavity is achieved under EUS guidance, after which the fistula is dilated to permit entry of a gastroscope for DEN. Clinical success rates of 75–91% have been reported. A pilot randomized trial showed that DEN reduced the pro-inflammatory response as well as the composite clinical end point of major complications compared with surgical necrosectomy. Although effective, there is a risk of significant morbidity and mortality. The extent and aggressiveness of DEN need to be individualized and weighed against the risks of complications.
KeywordsPancreatitis Necrosis Endoscopy Necrosectomy
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