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<p>Endoscopic step-up approach, which involves endoscopic ultrasound-guided drainage followed by necrosectomy, has been suggested as a potentially advantageous alternative to the surgical step-up approach for walled-off necrosis (WON) following acute pancreatitis. Recent studies indicate that although there is no significant difference in major complications or mortality between the two approaches, the endoscopic step-up approach is often preferred due to shorter hospital stays and lower re-intervention rates. However, a multidisciplinary approach should be considered for complex cases. Transgastric or transduodenal approaches can be challenging in cases of extensive intra-abdominal WON, whereas percutaneous endoscopic necrosectomy (PEN) has been reported as a safe and effective minimally invasive technique. We report the cases of two critically ill patients with extensive WON and uncontrolled sepsis who were successfully treated with simultaneous dual-endoscopic PEN. This approach may offer a promising strategy for enhancing treatment efficacy in extensive WON when performed appropriately.</p>

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Percutaneous endoscopic necrosectomy for extensive walled-off necrosis using two endoscopes simultaneously: a report of two cases

  • 期刊论文

  • 发表日期：

    2025年7月21日

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  • Keigo Oshiro,
  • Kazuo Hara,
  • Tomoki Ogata,
  • Hiroki Koda,
  • Nozomi Okuno,
  • Shin Haba,
  • Takamichi Kuwahara

摘要

Endoscopic step-up approach, which involves endoscopic ultrasound-guided drainage followed by necrosectomy, has been suggested as a potentially advantageous alternative to the surgical step-up approach for walled-off necrosis (WON) following acute pancreatitis. Recent studies indicate that although there is no significant difference in major complications or mortality between the two approaches, the endoscopic step-up approach is often preferred due to shorter hospital stays and lower re-intervention rates. However, a multidisciplinary approach should be considered for complex cases. Transgastric or transduodenal approaches can be challenging in cases of extensive intra-abdominal WON, whereas percutaneous endoscopic necrosectomy (PEN) has been reported as a safe and effective minimally invasive technique. We report the cases of two critically ill patients with extensive WON and uncontrolled sepsis who were successfully treated with simultaneous dual-endoscopic PEN. This approach may offer a promising strategy for enhancing treatment efficacy in extensive WON when performed appropriately.