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).
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Published online: August 13, 2015Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.