Percutaneous endoscopic necrosectomy using a novel slim gastroscope with a large working channel for pancreatic walled-off necrosis

Le résumé fourni par la source

Percutaneous endoscopic necrosectomy (PEN) is a vital salvage technique for infected walled-off necrosis (WON) caused by severe pancreatitis when transluminal access is anatomically unsafe or when the cavity extends into the pelvic region [ 1 ] [ 2 ] [ 3 ]. A standard therapeutic gastroscope with a large outer diameter requires dilation of the access route to approximately 30–34 Fr [ 1 ], resulting in delayed intervention. Meanwhile, an easy-access ultraslim endoscope cannot effectively evacuate the thick necrotic debris because of the narrow working channel [ 4 ]. Therefore, we investigated the newly developed 840TP gastroscope, which has a slim outer diameter of 7.9 mm, a large 3.2-mm working channel, and a working length of 1,100 mm [ 4 ], making it suitable for PEN in anatomically complex situations. The small outer diameter allows early access through a relatively small percutaneous tract without extensive dilation, while preservation of a large working channel permits the use of standard necrosectomy devices, including alligator forceps, five-pronged grasping forceps, and snares, as well as effective suction of viscous necrotic debris. We report the case of a middle-aged man with infected WON extending to the pelvic cavity following acute necrotizing pancreatitis. Since a safe route for endoscopic ultrasound-guided drainage was unavailable, a percutaneous drainage tube was placed ([ 5 ]; [ Fig. 1 ]). Despite the drainage, the infection persisted, necessitating a necrosectomy. Prior to the procedure, the percutaneous drainage tract was gradually upsized using drainage catheters; however, no additional tract dilation was performed at the time of endoscope insertion. At the time of the necrosectomy, the tract was occupied using an 18-Fr drainage tube and a 6-Fr catheter, creating a lumen of approximately 24 Fr. Because further dilation would have been required to introduce a standard therapeutic gastroscope and early necrosectomy was desirable given the patient’s severe inflammatory status and poor nutritional condition, a slim gastroscope was selected and successfully introduced into the WON via the existing percutaneous drainage route ([ Video 1 ]). The large working channel allowed the unhindered use of standard devices and effective suction of viscous necrotic debris ([ Fig. 2 ] and [ Fig. 3 ]). Furthermore, the widened 160° down-angulation and waterjet function facilitated efficient debridement, even in the difficult-to-reach pelvic extension. Complete necrosectomy was achieved over multiple sessions without intra-procedural or post-procedural adverse events. After the completion of treatment, the percutaneous drain was ultimately removed, and no repeat intervention was required. Although persistent external fistula formation is a potential long-term complication of percutaneous intervention, the fistula closed successfully in this case. Two months later, the WON was markedly diminished without additional interventions ([ Fig. 4 ] and [ Fig. 5 ]). PEN using a slim gastroscope, which enables early intervention through a small route and efficient suction, may be a promising treatment modality for complex WON, potentially leading to reduced procedural burdens and improved clinical outcomes. Fig. 1 a A computed tomographic image demonstrating walled-off necrosis extending into the pelvic cavity. The area outlined in white indicates the walled-off necrosis. b As a safe puncture route to the pelvic walled-off necrosis was not available, and two 10.2-Fr percutaneous drainage catheters were placed (highlighted in yellow). Download Video Percutaneous endoscopic necrosectomy using a novel slim gastroscope for pancreatic walled-off necrosis.Video 1 Fig. 2 A slim gastroscope, which features a slim 7.9-mm outer diameter and a large 3.2-mm working channel. Additionally, the down-angle has been expanded from 120° to 160°, and the scope includes a waterjet function. Fig. 3 Endoscopic views during percutaneous endoscopic necrosectomy. a Jet irrigation provided powerful lavage, allowing efficient visualization and facilitating continuous necrosectomy. b Necrotic tissue was fragmented using alligator forceps. c A five-pronged forceps was used in a manner similar to panel b . d After further necrosectomy, no residual necrotic tissue was observed. Fig. 4 Computed tomographic images obtained before the initiation of percutaneous endoscopic necrosectomy. The walled-off necrosis, outlined in white, extended into the pelvic cavity. a A coronal view. b and c Axial views. Fig. 5 Computed tomographic images obtained after the completion of percutaneous endoscopic necrosectomy, shown at the same levels as in [ Fig. 4 ]. The walled-off necrosis, outlined in white, was markedly reduced in size. a A coronal view. b and c Axial views. Endoscopy_UCTN_Code_TTT_1AR_2AI Publication History Article published online: 22 April 2026 © 2026. 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/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.