Necrosectomy performed by a single-use endoscope with a large operative working channel

A 61-year-old man with a large infected peripancreatic walled-off necrosis after acute pancreatitis [1] was managed with endoscopic ultrasound-guided placement of a lumen-apposing metal stent (20 × 10 mm Hot-Axios; Boston Scientific, Marlborough, Massachusetts, USA) for drainage [2] [3], followed by pneumatic dilation of the stent up to 15 mm and endoscopic necrosectomy ([Fig. 1], [Video 1]). After necrosectomy, two double-pigtail plastic stents, 7 Fr × 7 cm and 7 Fr × 5 cm, were placed with a stent-in-stent technique ([Fig. 2]). For necrosectomy we used a single-use endoscope with a large operative channel (4.2 mm) ([Fig. 3]).

Fig. 1 Direct endoscopic necrosectomy for management of walled-off necrosis.

Fig. 2 Scope suction during the procedure in order to facilitate necrosis removal.

Fig. 3 The large operative channel ensured efficient aspiration of substantial amounts of necrotic material.

Endoscopic ultrasound-guided drainage with placement of a lumen-apposing metal stent for a large infected walled-off necrosis. The sequence shows pneumatic dilation of the stent, endoscopic necrosectomy, and placement of two double-pigtail plastic stents with the stent-in-stent technique.Video 1

After 2 weeks, a computed tomography scan was performed, which confirmed the resolution of WON. The stent was then removed, and the patient was discharged without any complications.

Our case underlines the feasibility of performing endoscopic necrosectomy of an infected WON using a new single-use endoscope, theoretically avoiding the risk of scope infection [4]. Moreover, the large working channel (4.2 mm) may reduce procedure time and avoid multiple endoscopic sessions.

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Conflict of Interest

A. Fugazza is a consultant for Boston Scientific. M. Spadaccini and M. Colombo have received speaker fees from Boston Scientific. C. Hassan is a consultant for Fujifilm and Medtronic Co. A. Repici is a consultant for Fujifilm, Olympus Corp., Medtronic Co., and Boston Scientific. A. De Marco and F. Abubaker declare that they have no conflict of interest.

• References

• 1 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
• 2 Capurso G, Rizzo GEM, Coluccio C. et al. The i-EUS consensus on the management of pancreatic fluid collections – Part 1. Dig Liver Dis 2024; 56: 1663-1674
• 3 Capurso G, Coluccio C, Rizzo GEM. et al. The 1st i-EUS consensus on the management of pancreatic fluid collections – Part 2. Dig Liver Dis 2024; 56: 1819-1827
• 4 McCafferty CE, Aghajani MJ, Abi-Hanna D. et al. An update on gastrointestinal endoscopy-associated infections and their contributing factors. Ann Clin Microbiol Antimicrob 2018; 17: 36

Publication History

Article published online:
13 June 2025