VideoGIE| Volume 83, ISSUE 1, P255, January 2016

Direct endoscopic necrosectomy in retroflexion when using a lumen-apposing transmural covered metal stent

Published:August 13, 2015DOI:
      Direct endoscopic necrosectomy (DEN) is an effective method for the nonsurgical treatment of walled-off necrotic collections by means of debridement and drainage. Some aspects of the DEN technique are areas of ongoing debate, such as size or type of stent, need for simultaneous percutaneous drainage, specific approach to debridement, and number of repeated procedures. However, common to all approaches to DEN is the need for a stable, durable stomach-to-collection transmural tract for drainage and access. This is particularly important when a difficult endoscopic position is required, such as retroflexion. In this video, we demonstrate DEN while using a lumen-apposing transmural covered metal stent (Video 1, available online at The stent has a dumbbell-like shape because both ends have a flared contour, facilitating endoscope passage and debridement in the retroflexed position (Fig. 1).
      Figure thumbnail gr1
      Figure 1Lumen-apposing transmural covered metal stent facilitates direct endoscopic necrosectomy. A, The dumbbell-shaped stent is placed in the gastric fundus, visualized in retroflexed position. B, This facilitates passage of the scope into the collection for debridement.
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