Percutaneous endoscopic necrosectomy using an automated rotor resection device in severe necrotizing pancreatitis

Endoscopic transgastric necrosectomy is a first-line treatment for infected pancreatic necroses following acute pancreatitis [1] [2]. However, the accessibility of walled-off necrotic collections in the paracolic gutter often remains challenging. EndoRotor (Interscope Medical, Inc., Worcester, Massachusetts, USA) is a novel device for effective necrosectomy [2] [3] [4]. This is the first published case using it in a percutaneous setting.

We report the case of a 34-year-old man transferred to our hospital intensive care unit (ICU) following severe necrotizing pancreatitis. Complications such as sepsis, acute kidney failure requiring dialysis, and abdominal compartment resulted in a prolonged stay at our ICU.

Large, infected, walled-off necrotic collections remained in the left and right retroperitoneum. Owing to their location, the collections were not suitable for transgastric interventions and therefore percutaneous drainage was used as a primary therapy ([Fig. 1]).

Fig. 1 Computed tomography showed necrotic collections in the left and right lower retroperitoneal area. The percutaneous drainage tube can be seen on the right side of the patient.

At 3 months of percutaneous drainage and intravenous antibiotic therapy without resolution of the necrotic tissue in the left retroperitoneum, percutaneous endoscopic necrosectomy was performed twice using the novel EndoRotor resection device ([Video 1]). Percutaneous dilation was performed from 14 to 18 mm to allow insertion of the flexible endoscope into the retroperitoneal cavity. Necrosectomy was then carried out with the flexible EndoRotor device by using high suction (750 mmHg) and low cutting speed (1000 rpm).

Video 1 Percutaneous dilation and subsequent endoscopic necrosectomy was performed using the EndoRotor device (Interscope Medical, Inc., Worcester, Massachusetts, USA).

Except for the persistence of a cutaneous fistula for less than a week after intervention, no adverse events were observed. The patient’s condition improved, and he was discharged 7 days after the initial necrosectomy.

Endoscopy_UCTN_Code_TTT_1AO_2AN

Publication History

Article published online:
09 August 2021

• References

• 1 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13: e1-e15
• 2 Arvanitakis M, Dumonceau JM, Albert J. et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524-546
• 3 van der Wiel SE, Poley JW, Grubben M. et al. The EndoRotor, a novel tool for the endoscopic management of pancreatic necrosis. Endoscopy 2018; 50: E240-E241
• 4 Rizzatti G, Rimbas M, Impagnatiello M. et al. Endorotor-based endoscopic necrosectomy as a rescue or primary treatment of complicated walled-off pancreatic necrosis. A case series. J Gastrointestin Liver Dis 2020; 29: 681-684