Percutaneous hybrid necrosectomy combined with transgastric endotherapy in large walled-of necrosis: an observational feasibility study

Aims Although direct endoscopic necrosectomy (DEN) by transgastric approach is effective in most patients with infected walled-off necrosis (WON), some of them with very large and/or distal collections may need further therapies. Percutaneous hybrid necrosectomy (PHN) represents a new approach, combining the use of surgical clamps through the percutaneous fistula and a transgastric or percutaneous endoscopic guidance. The aim is to describe this innovative multidisciplinary technique.

Methods This is an observational single-center study. All consecutive patients presenting with large WON who underwent PHN in 2019-2023 were included. A classification in early (< 3 previous DEN) or late PHN (≥ 3) was retained. The primary outcome was clinical success, defined as symptom relief with WON complete resolution. The secondary aims were the time to WON resolution and the AE rate.

Results Of 51 patients presenting with WON, 15 (mean age: 59±12.7, 80% male) underwent DEN combined with PHN and were included. The median number DEN sessions were two. Overall, most patients required only one single PHN procedure (n=9, 60%) during an interval of 8 days (range: 2-14). Clinical success was 93.3%. The time to WON resolution was lower in early PHN strategy (13 vs. 30 days,p=0.024). The overall per-procedure AE rate was 10.5% during a median follow-up of 6.5 months (range: 3-49), with no procedure-related mortality.

Conclusions PHN under transgastric or percutaneous guidance represents a new minimally invasive and collaborative approach for selected patients with large WON. A low number of procedures are needed to achieve clinical success in a shorter time.

Publication History

Article published online:
27 March 2025