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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 www.giejournal.org). 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 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.
