CASES OF THE WEEK – “Endoscopic necrosectomy of large walled off pancreatic necrosis (pseudocyst with solid necrosis)” by Dr Piyush Somani, Specialist Gastroenterology, Al Zahra Hospital Sharjah

Endoscopic necrosectomy of large walled off pancreatic necrosis (pseudocyst with solid necrosis)

History: A 16 years old male, presented with intermittent abdominal pain with early satiety. There was a recent past history of acute idiopathic severe necrotising pancreatitis. CT abdomen was suggestive of large (12 cm X 11 cm) walled off peripancreatic fluid collection with solid necrosis suggestive of walled off pancreatic necrosis (WOPN). This WOPN was compressing the stomach wall. Patient underwent Endoscopic Ultrasound (EUS) guided drainage with HOT AXIOS stent.

After 1 week, patient underwent upper gastrointestinal endoscopy. AXIOS stent was seen inside the WOPN cavity. The cavity was partially filled with solid necrotic debris. Flushing/cleaning/removal of necrotic solid debris

(Endoscopic necrosectomy) was performed using multiple Roth nets of different sizes. This endoscopic necrosectomy was combined with continuous flushing of WOPN cavity with normal saline irrigation along with continuous suction of the debris and fluid. Large amounts of solid necrotic debris along with yellowish fluid was suctioned through the endoscope channel.

In summary, Endoscopic necrosectomy of large walled off pancreatic necrosis is a highly advanced endoscopic technique available only in few hospitals in UAE. It is associated with major complications and needs to be performed at specialized centres with expertise.

It is minimally invasive technique for the removal of large, symptomatic peripancreatic walled off necrosis.

This is the first case of Endoscopic necrosectomy performed in Al Zahra Hospital, Sharjah.