Open Access
CC BY 4.0 · Endoscopy 2025; 57(S 01): E572-E573
DOI: 10.1055/a-2598-3566
E-Videos

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

1   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
,
Marco Spadaccini
1   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
Alessandro De Marco
1   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
Faisal Abubaker
3   King Hamad University Hospital, Al Sayh, Bahrain
,
Matteo Colombo
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
1   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
Alessandro Repici
1   Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS, Rozzano, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
› Institutsangaben
 

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]).

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Fig. 1 Direct endoscopic necrosectomy for management of walled-off necrosis.
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Fig. 2 Scope suction during the procedure in order to facilitate necrosis removal.
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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.

Endoscopy_UCTN_Code_TTT_1AS_2AJ

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

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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.


Correspondence

Marco Spadaccini, MD
Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital – IRCCS
Via Manzoni 56
Rozzano 20089, Milano
Italy   

Publikationsverlauf

Artikel online veröffentlicht:
13. Juni 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Direct endoscopic necrosectomy for management of walled-off necrosis.
Zoom
Fig. 2 Scope suction during the procedure in order to facilitate necrosis removal.
Zoom
Fig. 3 The large operative channel ensured efficient aspiration of substantial amounts of necrotic material.