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DOI: 10.1055/a-1151-4694
Endorotor-based endoscopic necrosectomy avoiding the superior mesenteric artery
A 67-year-old man with a 15-cm pancreatic necrotic collection was transferred to our unit after 2 months’ hospitalization for necrotizing pancreatitis. His conditions was poor, with decreased mental status, high fever, neutrophilic leukocytosis (white blood cells 27.6 × 109/L, neutrophils 93.1 %), and signs of sepsis (C-reactive protein 150.5 mg/L, procalcitonin 9.83 ng/mL).
Emergency endosonography-guided drainage using a 15 × 10 mm Axios stent (Boston Scientific, Marlborough, Massachusetts, USA) mounted onto a cautery device was successfully performed. During the procedure a major vessel was observed inside the collection. He was sent for embolization but angio-computed tomography revealed the vessel to be the superior mesenteric artery (SMA) and embolization prior to direct endoscopic necrosectomy (DEN) was aborted. A decision to pursue DEN was made and the Endorotor system (Interscope, Inc., Whitinsville, Massachusetts, USA) ([Fig. 1]), which allows constant endoscopic visualization during necrosectomy ([Fig. 2]), was utilized. The procedure was performed using a dedicated Endorotor XT catheter, high rotating speed (1700 rpm), and progressive increase of suction up to 60 L/min ([Fig. 3]), with careful visualization of the site at which the catheter was active ([Video 1]).
Video 1 Endoscopic necrosectomy with Endorotor (Interscope, Inc., Whitinsville, Massachusetts, USA), avoiding the superior mesenteric artery.
Quality:
After two DEN sessions (40 and 120 minutes’ duration, respectively), without any complications, only minimal debris remained in the area proximal to the SMA. A double-pigtail stent was placed through the Axios stent and the patient was discharged home.
At 3 weeks’ follow-up, both stents were removed, and the patient remained in good clinical condition thereafter.
Endorotor is a new endoscopic rotating morcellator device, which reported successful accomplishment of DEN in two patients in whom conventional necrosectomy failed [1], and in another patient [2] with a collection containing 70 % necrotic content. In our case, the Endorotor catheter performed DEN under constant endoscopic visualization, allowing successful treatment despite the presence of the SMA inside the collection.
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Competing interests
Dr. Larghi has received fees for lecture and training from Pentax Medical and Boston Scientific. He has also received research grant from Medtronic.
Prof. Costamagna is a consultant for Olympus Medical, Boston Scientific Corp., Cook Medical.
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References
- 1 van der Wiel SE, Poley JW, Grubben MJAL. et al. The EndoRotor, a novel tool for the endoscopic management of pancreatic necrosis. Endoscopy 2018; 50: E240-E241
- 2 Bazarbashi AN, Ge PS, de Moura DTH. et al. A novel endoscopic morcellator device to facilitate direct necrosectomy of solid walled-off necrosis. Endoscopy 2019; 51: E396-E397
Corresponding author
Publication History
Article published online:
24 April 2020
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References
- 1 van der Wiel SE, Poley JW, Grubben MJAL. et al. The EndoRotor, a novel tool for the endoscopic management of pancreatic necrosis. Endoscopy 2018; 50: E240-E241
- 2 Bazarbashi AN, Ge PS, de Moura DTH. et al. A novel endoscopic morcellator device to facilitate direct necrosectomy of solid walled-off necrosis. Endoscopy 2019; 51: E396-E397