Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting.

Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device / Binda, Cecilia; Coluccio, Chiara; Vizzuso, Antonio; Sartini, Alessandro; Sbrancia, Monica; Cucchetti, Alessandro; Giampalma, Emanuela; Fabbri, Stefano; Ercolani, Giorgio; Fabbri, Carlo. - In: DIAGNOSTICS. - ISSN 2075-4418. - ELETTRONICO. - 13:14(2023), pp. 2321.1-2321.8. [10.3390/diagnostics13142321]

Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device

Binda, Cecilia;Sartini, Alessandro;Cucchetti, Alessandro;Ercolani, Giorgio;Fabbri, Carlo
2023

Abstract

Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting.
2023
Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device / Binda, Cecilia; Coluccio, Chiara; Vizzuso, Antonio; Sartini, Alessandro; Sbrancia, Monica; Cucchetti, Alessandro; Giampalma, Emanuela; Fabbri, Stefano; Ercolani, Giorgio; Fabbri, Carlo. - In: DIAGNOSTICS. - ISSN 2075-4418. - ELETTRONICO. - 13:14(2023), pp. 2321.1-2321.8. [10.3390/diagnostics13142321]
Binda, Cecilia; Coluccio, Chiara; Vizzuso, Antonio; Sartini, Alessandro; Sbrancia, Monica; Cucchetti, Alessandro; Giampalma, Emanuela; Fabbri, Stefano; Ercolani, Giorgio; Fabbri, Carlo
File in questo prodotto:
File Dimensione Formato  
2023-Binda (Diagnostics)-Direct endoscopic necrosectomy of recuttent.pdf

accesso aperto

Tipo: Versione (PDF) editoriale
Licenza: Licenza per Accesso Aperto. Creative Commons Attribuzione (CCBY)
Dimensione 2.79 MB
Formato Adobe PDF
2.79 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/961470
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 0
  • ???jsp.display-item.citation.isi??? 0
social impact